Jolly S

Kundu N

Rathnayake S

2023-01-19

Laparoscopic cholecystectomy is a common surgical procedure, with potential for significant morbidity. The incidence of bile duct injuries has increased with the advent of laparoscopy, occurring in up to 1% of cases. Risk of injury increases with aberrant anatomy, acute inflammation and fibrosis. Preventative strategies include obtaining the critical view of safety, using a fundus-first approach and performing a subtotal cholecystectomy in the difficult gallbladder. Although controversy exists for routine cholangiography, its use is helpful in situations of obscure anatomy. We describe the case of a chronically inflamed and unusually small 1.5 cm gallbladder with an obliterated cystic duct. The critical view of safety was not able to be achieved and intraoperative cholangiography enabled identification of aberrant anatomy, with a dilated common duct mistaken as the gallbladder infundibulum. This case highlights the need to be vigilant to structural variation and the utility of selective cholangiography to clarify anatomy.

Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.

General Surgery, Royal Darwin Hospital, Tiwi, Australia.

Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2023.

J Surg Case Rep. 2023 Jan 19;2023(1):rjad001. doi: 10.1093/jscr/rjad001. eCollection 2023 Jan.

0000-0002-7674-508X

https://pubmed.ncbi.nlm.nih.gov/36685134/?otool=iaurydwlib

https://hdl.handle.net/10137/12381

2023

A case of mistaken identity: bile duct masquerading as gallbladder.

Case Reports

Publication