Duplicated common bile duct: a recipe for biliary injury. Report of a new variant

Abstract

Duplicated common bile duct, often associated with conditions like lithiasis, biliary cysts and pancreatobiliary maljunction, could result in highly morbid and potentially fatal biliary injuries. Precise preoperative diagnosis and classification still remain a challenge. A female patient undergoing emergency laparoscopic cholecystectomy for acute calculous cholecystitis sustained iatrogenic bile duct injury. A drainage tube was placed into the injured duct for post-operative conservative management. Post-operative tube cholangiogram revealed a double common bile duct with cystic duct opening distally. This was identified as a new variant not previously reported or classified. However rare, duplicated common bile duct could result in serious iatrogenic bile duct injury if unidentified during surgery. Knowledge of its existence is essential to avoid such injuries as preoperative diagnosis still remains a challenge. A thorough clinical and morphological study of previously reported variants is needed for a comprehensive classification to encompass newly discovered variants.

A proposed feasible classification of common bile duct duplications based on a newly described variant and review of existing literature

“…A and B coronal and axial magnetic resonance T2-weighted image showed the low signal septum in the dilated common bile duct which divided the extrahepatic bile duct into two parts, which connected to the left and the right hepatic duct respectively. C and D coronal maximum intensity projection magnetic resonance image and volume rendering image showed the dilated and duplicated common bile duct however, none of these were classified into classification system [8][9][10][11] (Fig. 4).…”

“…B Variant described by Kosar et al [ 9 ]. C Variant described by Nuamah et al [ 10 , 11 ]. D Variant described in our report

Fig.

…”