A Double Cystic Duct With a Single Gallbladder Successfully Treated With Laparoscopic Cholecystectomy: A Challenge to Laparoscopic Surgeons (original) (raw)
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Case report of a duplicated cystic duct: A unique challenge for the laparoscopic surgeon
International Journal of Surgery Case Reports, 2019
INTRODUCTION: Anatomical variants of the extrahepatic biliary tree are numerous, adding significantly to the risk of bile duct injury during cholecystectomy, especially when laparoscopic approach is employed. Duplicated cystic ducts draining a single gallbladder are extremely rare. PRESENTATION OF CASE: A 34-year-old female presented with signs and symptoms of acute cholecystitis which was confirmed on imaging. She was found to have an accessory cystic duct on laparoscopic cholecystectomy requiring conversion to open laparotomy with intraoperative cholangiogram to delineate the anatomy. DISCUSSION: In the English literature, there has been 20 reported cases of double cystic duct with a single gallbladder. Most of these cases were diagnosed intraoperatively despite the completion of a preoperative endoscopic retrograde cholangiopancreatography in a few of these patients. CONCLUSION: The limited success of preoperative biliary tract imaging in demonstrating anatomic aberrancies prior to cholecystectomy clearly highlights the importance of maintaining constant vigilance for even the slightest anatomic abnormality at operation. Any uncertainty or concern for ductal injury mandates immediate operative cholangiogram with cannulation of all structures in question.
2024
Introduction and Importance: A double cystic duct with a single gallbladder is one of the extremely uncommon variations of the cystic duct and only a few cases were reported in literature. Case Presentation: A 33-year-old female, with an unremarkable medical history, presented to the emergency department with a 2-day history of right upper quadrant abdominal (RUQ) pain. The abdominal pain was gradually increasing in intensity radiating to the back and was associated with anorexia and multiple episodes of vomiting. Abdominal examination revealed RUQ pain and tenderness. Abdominal ultrasonography was performed, showing a markedly distended gallbladder with evidence of a few calculi one of which was impacted at the neck. laparoscopic cholecystectomy was done within 2 days of admission during which another luminal structure was identified that suggested a double cystic duct. Clinical Discussion: Anomalies of the biliary tree are common with the classical anatomical picture presenting in only 33% of cholecystectomy cases. However, the presence of a double cystic duct is a rare variation, especially in the case of a single gallbladder. The identification of such anomaly can be achieved preoperatively using imaging modalities or it can be identified during the surgical procedure itself. such identification reduces the chances of postoperative comorbidities. Conclusion: Pre-operative identification of biliary tract anomalies by different imaging modalities is limited. Hence the importance of cautiousness and achieving a proper critical view of s afety intraoperatively to prevent possible complications intra-and post-operatively. Our case report emphasizes the diagnostic and surgical challenges of the double cystic duct.
Experimental and therapeutic medicine, 2016
A double gallbladder is a rare congenital malformation. The present study describes a case of double gallbladder with secondary common bile duct stones. By way of laparoscopic choledochoscopy, the exploration and removal of a common bile duct stone was performed through the cystic duct. The process involved a primary suture of the cystic duct and was performed without using a T-tube, and completed a surgical removal of the gallbladder. The present case was successfully treated by laparoscopic surgery. From a review of previous studies published in the English language, this study, to the best of our knowledge, is the first report of such a case. Therefore, laparoscopic dissection is safe for the removal of a double gallbladder and for exploration of the common duct by choledochoscopy.
Duplicated gallbladder with double cystic duct: A case report
Gallbladder duplication can present a clinical challenge primarily due to difficulties with diagnosis and identification. Recognition of this anomaly and its various types is important since it can complicate a gallbladder disease or a simple hepatobiliary surgical procedure. The case report of a 60 year-old male who presented acute cholecystitis, with previous history of abdominal operations. In control study for cholecystitis (US) and MRCP and 3D reconstructions, the two cystic ducts with one common bile duct were identified. Underwent a surgical management (open procedure due to multiple previous operation for ulcer perforation, umbilical hernia repair) of symptomatic gallbladder duplication , emphasizing several important consideration Gallbladder duplication is a rare congenital malformation, that occurs in about one in 3800-4000 births. Congenital anomalies of the gallbladder and anatomical variations of their positions are associated with an increased risk of complications after laparoscopic or open cholecystectomy. Preoperative imaging is often helpful for diagnosis. Malformations
Laparoscopic double cholecystectomy for duplicated gallbladder: A case report
International Journal of Surgery Case Reports
INTRODUCTION: Duplication of the gallbladder (GB) is a very rare surgical encounter affecting 1 in 4000-5000 population that often eludes detection on preoperative ultrasonography, and might increase operative difficulty and risk. The H-type anomaly is the most common whereby each GB drains into the common bile duct via a separate cystic duct. PRESENTATION OF CASE: We report a young female patient with symptomatic gallstones who was incidentally found to have abnormal biliary anatomy on a CT colonography and an H-type duplication of the GB on MRCP. A challenging laparoscopic double cholecystectomy was performed uneventfully. DISCUSSION: Gallbladder duplication can be classified as a type-I anomaly (partiality split primordial gallbladder), a type-II anomaly (two separate gallbladders, each with their own cystic duct) or a rare type-III anomaly (triple gallbladders draining by 1-3 separate cystic ducts). Such anatomical variations are associated with increased operative difficulty and risks, including conversion to open cholecystectomy and common bile duct injury. CONCLUSION: A young female patient was pre-operatively diagnosed with a Harlaftis's type-II GB anomaly. Each gallbladder was drained by a distinct cystic duct (H-type anomaly). A laparoscopic cholecystectomy was performed with no complications afterwards. Awareness of this rare anomaly might require intraoperative cholangiography when initially suspected during a cholecystectomy to facilitate anatomical recognition and avoid missing a symptomatic pathologic GB and the need for a repeat cholecystectomy.
JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
Congenital malformation of the gallbladder and cystic duct that cause operative difficulty are rare developmental abnormalities of embryogenesis. We report the case of a 47-year-old male patient who presented with right upper quadrant pain, tenderness, mild jaundice, moderately elevated liver function tests, and ultrasound evidence of acute calculus cholecystitis. Magnetic resonance cholangiopancreatography (MRCP) excluded choledocholithiasis, but revealed the cystic duct anomaly. A difficult laparoscopic cholecystectomy was performed successfully. This is an unusual case of laparoscopic cholecystectomy for severe acute calculus cholecystitis in a patient with very low conjunction to the common bile duct (CBD) of a long, parallel cystic duct.
Co-existence of Double Gallbladder and Choledochal Cyst in a Single Patient
Cureus, 2021
Additional anatomical structures are rare but can be mistaken for other conditions, causing misdiagnoses and poor outcomes for patients. The presence of concurrent anomalies within the extra structures further complicates a rare situation. We present a case of a patient with two gallbladders and a choledochal cyst diagnosed via radiography and confirmed by exploratory laparotomy. He underwent a cholecystectomy, choledochal cyst resection, and hepaticojejunostomy, and he was doing well as of his last follow-up. This case highlights the need to consider radiological imaging in patients with choledochal cysts carefully.
Journal of Liaquat University of Medical & Health Sciences
BACKGROUND:. During cholecystectomy, to avoid common bile duct injury or other per operative complication, the knowledge of cystic cyst anomalies is imperative. This study aimed to highlight cystic duct anomalies identified during laparoscopic cholecystectomy and report their implications. METHODS: This prospective study was conducted at Liaquat University of Medical & Health Sciences, Jamshoro over a period of six years (2009-2014) in the department of Surgery. Over this specified period a total of 775 patients underwent cholecystectomy and were included in this study. RESULTS: Among 775 patients who underwent laparoscopic cholecystectomy, abnormal confluence was found in 7.22%, short cystic duct in 26.78%, long cystic duct in 17.86% and double cystic duct in 12.50%. Surgical problems encountered due to these variations were cystic duct avulsion, common bile duct injury, bleeding and bile leak. CONCLUSION: During laparoscopic cholecystectomy, unidentified anatomical variations of cystic duct may cause drastic complications including ductal injuries which significantly increase morbidity and may raise mortality.
Translational Biomedicine, 2016
Cholecystectomy is the most commonly performed elective surgery worldwide. Variations in the normal anatomy of the biliary tree are common. Cystic duct variations are surgically most significant. Incidence of cystic duct opening into right hepatic duct is very low. In the case presented in this report cystic duct opened into the right hepatic duct. An abnormally wide cystic duct made us suspicious and after careful dissection we could trace the cystic duct entering into right hepatic duct. Various radiologic investigations like ERCP (endoscopic retrograde cholangiopancreatography), MRCP (magnetic resonance cholangiopancreatography), Helical CT (computerized tomography) can give us excellent picture of biliary tree but they are seldom used preoperatively. Hence the proper knowledge of normal anatomy and anomalies of the biliary tree can help to avoid disasters during cholecystectomy, especially for surgeons beginning their careers.