The dilemma of the duplicated cystic duct: a case report

Abstract

We present a rare case of a duplicated cystic duct encountered during an elective laparoscopic cholecystectomy in a patient with biliary colic. Prompt recognition of an intraoperative bile leak followed by thorough examination and recognition of the source allowed for timely and appropriate management of the affected patient with a satisfactory post-operative outcome. Our case is unique by the lack of availability of intraoperative cholangiogram at the time of surgery, which posed a significant diagnostic and therapeutic challenge, and by how aberrant anatomy was confirmed intraoperatively by reviewing prior cardiac magnetic resonance imaging. Unremarkable preoperative imaging does not rule out the presence of abnormal anatomy. Early involvement of a specialist hepatobiliary surgeon is essential in an unexplained bile leak, with a low threshold in converting to an open procedure if there is difficulty in clearly deciphering anatomy.

A Case of Postoperative Biliary Leak in a Patient With Duplicated Cystic Ducts

“…Many diagnostic modalities have been implemented preoperatively to help diagnose cystic duct anomalies, namely, ERCP, endoscopic ultrasound, CT, and MRCP [ 1 ]. Unfortunately, cystic duct anomalies are oftentimes not properly identified on preoperative imaging [ 2 - 4 ]. According to Anisi et al, multiple studies have attempted to determine ideal diagnostic imaging for cystic duct anomalies [ 1 ].…”

“…The ideal treatment for bile duct injuries is when they are discovered intraoperatively. It is important to monitor patients postoperatively for bile leak, even if biliary injury was found and treated intraoperatively [ 4 ]. A common treatment for postoperative bile leak is ERCP with stent placement, which helps facilitate bile flow, allowing passive leak healing [ 5 , 6 , 8 ].…”

“…Duplicated cystic ducts with a single gallbladder, with less than 20 reported cases before 2019, are a rare congenital malformation that is typically diagnosed intraoperatively or postoperatively due to complications [ 1 - 4 ]. It is important to identify these anomalies in the periprocedural setting to reduce the risk of postoperative complications, including bile duct injuries and subsequent biliary leaks that increase postoperative morbidity and mortality [ 1 - 6 ].…”

Gallbladder cancer spreading into the aberrant cystic duct: First literature report

“…Although anatomical variations in the cystic duct are quite common, a duplicate cystic duct draining a single gallbladder is an extremely rare anomaly of the biliary tract, with 29 cases having been reported in the literature worldwide, including our case [1] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] . In addition, no report of gallbladder cancer spreading into the aberrant cystic duct was found, so our present case is the first case report in the global literature.…”