Cholecystohepatic duct detected during laparoscopic cholecystectomy: a case report

Abstract

Background The cholecystohepatic duct is a rare form of an aberrant hepatic duct that connects to the gallbladder. Although cholecystohepatic duct is reported to be a very rare anomaly, injury of cholecystohepatic duct during cholecystectomy may result in serious complications. Herein, we present a case of cholecystohepatic duct in the ventral branch of the right posterior inferior segmental bile duct detected during laparoscopic cholecystectomy. Case presentation A 77-year-old woman with cholecystolithiasis had been referred to our hospital for surgery. Drip infusion cholecystocholangiography-computed tomography revealed a bile duct branch without communication between the intra- and extrabiliary systems, although the existence of this aberrant hepatic duct was not suspected preoperatively. A 4-port laparoscopic cholecystectomy was performed. After critical view of safety was confirmed, the cystic artery and duct were divided after double clipping. During antegrade mobilization of the gallbladder from the gallbladder bed, a thin, white cord-like material connecting the gallbladder neck and bed was detected. After clipping and dividing it, a cholecystohepatic duct injury was recognized through rechecking the results of the preoperative examinations. Biliary reconstruction was considered unnecessary because of the lesion’s small drainage area. The postoperative course was uneventful, and an enhanced computed tomography performed 6 months after the surgery revealed a dilation in the ventral branch of the right posterior inferior segmental bile duct. The patient’s liver function remained normal, and she had no symptoms of cholangitis 42 months after the surgery. Conclusions Although cholecystohepatic duct is a rare anomaly compared to other aberrant hepatic ducts, surgeons performing cholecystectomy should always keep its existence in mind to avoid serious postoperative complications. Ideally, preoperative detection of cholecystohepatic duct is preferable, but even if it is detected during surgery, the appropriate management according to the drainage area is also important.

Cholecysto-hepatic duct serving as the only drainage pathway of bile from the intrahepatic to the extrahepatic biliary system in an infant: a case report

“…Main surgical management involved partial cholecystectomy and choledochoplasty, Roux-en-Y hepaticojejunostomy with the RPD or anastomosis with the cystic duct, cholecystoduodenostomy, primary anastomosis and biliary reconstruction, and closure of the duct if the drainage area was small [1,6]. Our patient is another example of cholecystohepatic duct serving as the only drainage pathway from intrahepatic ducts toward the gallbladder, which is a unique case from several perspectives.…”

“…Cholecystohepatic duct is an uncommon anomaly of the biliary system and occurs in 0.7-1.2% of the population [1,2]. Only 29 cases of cholecystohepatic duct with agenesis of CBD/CHD are reported in the literature since 1945 [5][6][7].…”

“…Aberrancies in the biliary ductal system is defined as bile ducts that directly drain a portion of the liver into the extrahepatic biliary system, cystic duct, or gallbladder, the latter being specified as a cholecystohepatic duct; a very rare malformation with few cases reported in the literature [1,2].…”

Diagnosis of a single gallbladder with double cystic ducts and dominant accessory duct draining into the right hepatic duct: a case report

“…6 The incidence of cholecystohepatic duct anomaly is much lower than that of other aberrant hepatic ducts and is thought to arise as a result of abnormal biliary tract embryology. 7 Among the hepatic duct anomalies, a single gallbladder with double cystic ducts is extremely rare, with only a few cases reported in the English language literature. 3,4 A comprehensive surgical approach during cholecystectomy is mandatory for patients with a cholecystohepatic duct anomaly.…”

“…3,4 A comprehensive surgical approach during cholecystectomy is mandatory for patients with a cholecystohepatic duct anomaly. 7 Injury to the bile duct may result in bile leakage, bile duct stricture, cholangitis, or liver abscess, and surgical injury related to this biliary anomaly have been reported with morbidities in 0.2-2% of cases after laparoscopic cholecystectomy. 8 Such an injury was highly likely to occur in the present case, as the right hepatic duct being mistaken for the cystic duct may have been erroneously ligated and divided during surgery.…”