Asian Journal of Case Reports in Surgery

An Incidental Finding of Double Cystic Ducts during Laparoscopic Cholecystectomy: A Case Report

Amine Bachar

General Surgery Department, Ibn Rochd University Hospital of Casablanca, Morocco.

Abderrahmane Lamnaouar

General Surgery Department, Ibn Rochd University Hospital of Casablanca, Morocco.

Hamza El Khou *

General Surgery Department, Ibn Rochd University Hospital of Casablanca, Morocco.

Taoufik El Abbassi

General Surgery Department, Ibn Rochd University Hospital of Casablanca, Morocco.

Mohamed Rachid Lefriyekh

General Surgery Department, Ibn Rochd University Hospital of Casablanca, Morocco.

*Author to whom correspondence should be addressed.

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Abstract

Introduction: Abnormal anatomy of the biliary duct are common, and failure to recognize them may lead to complications during operative or endoscopic procedures. The diagnosis is usually established during surgery.

Presentation of the Case:  we have reported the case of a 46-year-old patient with a history of epilepsy and psychosis under treatment, presenting upper right abdominal pain, admitted at an academic medical center, with the intra operative discovery of a duplicated biliary duct, the accessory cystic duct was anterior the primary cystic duct and drained in the common biliary duct, both cystic ducts were clipped, and no complications occurred during or after the laparoscopic cholecystectomy.

Discussion: Double gall bladders with double cystic ducts are not an uncommon occurrence, however a double cystic duct with a sing gall bladder is a an extremely rare biliary duct abnormality, several authors reported the need to rely on per operative cholangiography to mitigate the risk of biliary injury.

Conclusion: Surgeons must be aware of the different biliary duct abnormalities to minimize the risk for the patients.

Keywords: Cystic duct duplication, laparoscopic cholecystectomy, biliary duct abnormality

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References

Agha RA, Franchi T, Sohrab C, Mathew G, Kirwan A, Thomas A, et al. The SCARE 2020 guideline: Updating consensus Surgical Case Report (SCARE) guidelines. International Journal of Surgery. 2020; 84(1):226-30.

H. P. Klotz, R. Schlumpf, F. Largiader, Injury to an accessory bile duct during laparoscopic cholecys- tectomy, Surg. Laparosc. Endosc. 1992;2:317–337.

Khayat MF, Al-Amoodi MS, Aldaqal SM, Sibiany A. Abnormal anatomical variations of extra- hepatic biliary tract, and their relation to biliary tract injuries and stones formation, Gastroenterology Res. 2014;7: 12–18.

Available:http://dx.doi.org/10.14740/gr596e

Senapati A, Wolfe JHN. Accessory cystic duct - An operative hazard. Journal of the Royal Society of Medicine. 1984;77(10): 845–846. Available:https://doi.org/10.1177/014107688407701009

Flannery MG, Caster MP. Congenital abnormalities of gall bladder: 101 cases, Int Abstr Surg. 1956;103:439– 457. DOI: 10.12659/AJCR.905963

Tsutsumi S, Hosouchi Y, Shimura T. Double cystic duct detected by endoscopic retrograde cholan- giopancreatography and confirmed by intraoperative cholangiography in laparoscopic cholecystectomy. Hepatogastroenterology. 2000;47:1266–1268.

Hirono Y, Takia Y, Nitta N, Hashimoto H. Double cystic duct found by intraoperative cholangiography in laparoscopic cholecystectomy, Surg Laparosc Endosc. 1997;7:263–265.

Blumgart LH, Hann LE. Surgical and Radiological anatomy of the liver and the biliary tract, W B Saunders, London; 2000. Available:https://doi.org/10.1016/B978-1-4377-1454-8.00107-7

Ong WM, Cheng Y. Intraoperative diagnosis of a duplicated cystic duct. ANZ Journal of Surgery. 2019;89:E464-E465. Available:https://doi.org/10.1111/ans.14763

Huston TL, Dakin GF. Double cystic duct. Can J Surg. 2008;51(1):9-10.