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

Biliary anomalies are a high risk for biliary injury during surgery, and although a biliary anomaly is occasionally encountered, variations in cystic ducts are rare. A preoperative diagnosis is highly valuable in facilitating surgical procedures and avoiding surgical complications. Herein, the case of a 67-year-old female patient with acute cholecystitis, in which preoperative fluoroscopic cholangiography clearly demonstrated a single gallbladder with double cystic ducts, is presented. The accessory duct was found to be dominant, draining into the otherwise normal right intrahepatic bile duct, and laparoscopic cholecystectomy was performed smoothly and successfully. Fluoroscopic cholangiography is a powerful tool that may clearly depict the anomaly of a single gallbladder with double cystic ducts. Through appropriate preoperative knowledge and demonstration of this biliary anomaly in the present case, laparoscopic cholecystectomy was safely performed, and the patient was symptom-free at the 3-year follow-up assessment.

Hepaticocystic Duct in an Era of Laparoscopic Cholecystectomy

The biliary tract is notorious for its variable anatomy. A persistent hepaticocystic duct with agenesis of common bile duct is a rare biliary anomaly that creates a diagnostic dilemma and can add to the operative difficulties. It is important to diagnose this anomaly preoperatively since the gallbladder forms an integral part of bilioenteric continuity and an inadvertent cholecystectomy can lead to a surgical catastrophe. If diagnosed, surgeons can plan definitive treatment in the form of biliary diversion. We present a case of a 22-year-old man, who presented to us with obstructive jaundice and cholangitis. The biliary system was decompressed initially with a percutaneous transhepatic biliary drainage and an endoscopic retrograde cholangiogram established the diagnosis of a type IV hepaticocystic duct preoperatively in our case. Since diagnosis was made prior to operative intervention, we were able to perform a cholecystojejunostomy to maintain biliary continuity. The patient was discharged with an uneventful postoperative course. To our knowledge, this is the first report of such a variation being diagnosed preoperatively. We are also presenting a brief review of literature about persistent hepaticocystic ducts and the embryological basis of their origin.

A Case of Double Gallbladder with Adenocarcinoma Arising from the Left Hepatic Duct: A Case Report and Review of the Literature

Double gallbladder is a rare congenital biliary anomaly, but an accessory gallbladder arising from the left hepatic duct is a more remarkably rare congenital anomaly. We report a case of double gallbladder with adenocarcinoma and gallstones, which was preoperatively diagnosed by endoscopic retrograde cholangiopancreatography (ERCP) and then confirmed by open laparotomy. A review of the literature is presented.