Cystic duct entering to right hepatic duct; a case report with literature review

Mahmoodreza Khoonsari; Mohsen Reza Mansoorian; Abolfazl Namazi; Ali Kabir

doi:10.1016/j.ijscr.2023.108222

Cystic duct entering to right hepatic duct; a case report with literature review

Int J Surg Case Rep. 2023 May:106:108222. doi: 10.1016/j.ijscr.2023.108222. Epub 2023 Apr 15.

Authors

Mahmoodreza Khoonsari¹, Mohsen Reza Mansoorian², Abolfazl Namazi¹, Ali Kabir³

Affiliations

¹ Gastrointestinal and Liver Disease Research Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.
² Gastrointestinal and Liver Disease Research Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran; Department of Surgery, Transplantation Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Tehran, Iran.
³ Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran. Electronic address: kabir.a@iums.ac.ir.

Abstract

Introduction and importance: Surgeons may mistakenly consider the right hepatic duct as cystic duct, ligate, and divide it.

Case presentation: A 58-year-old woman presented with right upper quadrant (RUQ) abdominal pain, nausea, and RUQ tenderness, but negative Murphy's sign. Common bile duct was 10 mm based on abdominal ultrasound. Common hepatic duct and intrahepatic ducts consist of multiple common bile duct (CBD) stones with sludge and multiple small gallstones. Different diagnostic procedures (Computed tomography (CT) scan, magnetic resonance cholangiopancreatography (MRCP), and endoscopic retrograde cholangiopancreatography (ERCP)) showed the connection of the cystic duct to the right hepatic duct. Balloon sweeping for stones extraction and then laparoscopic cholecystectomy was successfully done.

Clinical discussion: Radiologic evaluations like MRCP, CT scan, ERCP or sonography before or during the surgery/endoscopic interventions seem logical at least for selected patients.

Conclusion: Before endoscopic/surgical interventions we need to be sure about the anatomy of biliary tree by a suitable para-clinic evaluation.

Keywords: Case report; Computed tomography; Cystic duct; Endoscopic retrograde cholangiopancreatography; Hepatic duct; Magnetic resonance cholangiopancreatography.

Publication types

Case Reports