A case of mistaken identity: bile duct masquerading as gallbladder
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. Pr...
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| Published in | Journal of surgical case reports Vol. 2023; no. 1; p. rjad001 |
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| Main Authors | , , |
| Format | Journal Article |
| Language | English |
| Published |
England
01.01.2023
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| Online Access | Get full text |
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| Abstract | 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. |
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| AbstractList | 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. |
| Author | Kundu, Nikhil Rathnayake, Suraj Jolly, Samantha |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/36685134$$D View this record in MEDLINE/PubMed |
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| References | Strasberg (2023011920393665900_ref6) 2000; 191 Jha (2023011920393665900_ref7) 2020; 19 Graaf (2023011920393665900_ref4) 2018; 60 Deangelis (2023011920393665900_ref2) 2021; 16 Karvonen (2023011920393665900_ref3) 2007; 21 Strasberg (2023011920393665900_ref5) 2010; 211 Qureshi (2023011920393665900_ref8) 2009; 13 Pesce (2023011920393665900_ref1) 2019; 12 |
| References_xml | – volume: 12 start-page: 121 year: 2019 ident: 2023011920393665900_ref1 article-title: Iatrogenic bile duct injury: impact and management challenges publication-title: Clin Exp Gastroenterol doi: 10.2147/CEG.S169492 contributor: fullname: Pesce – volume: 21 start-page: 1069 year: 2007 ident: 2023011920393665900_ref3 article-title: Bile duct injuries during laparoscopic cholecystectomy: primary and long-term results from a single institution publication-title: Surg Endosc doi: 10.1007/s00464-007-9316-7 contributor: fullname: Karvonen – volume: 13 start-page: 605 year: 2009 ident: 2023011920393665900_ref8 article-title: Aberrant presentation of the gallbladder during laparoscopic cholecystectomy publication-title: Jsls doi: 10.4293/108680809X12589999538075 contributor: fullname: Qureshi – volume: 211 start-page: 132 year: 2010 ident: 2023011920393665900_ref5 article-title: Rationale and use of the critical view of safety in laparoscopic cholecystectomy publication-title: J Am Coll Surg doi: 10.1016/j.jamcollsurg.2010.02.053 contributor: fullname: Strasberg – volume: 19 start-page: 274 year: 2020 ident: 2023011920393665900_ref7 article-title: Importance of Rouviere's sulcus in laparoscopic cholecystectomy publication-title: Ann Afr Med doi: 10.4103/aam.aam_4_20 contributor: fullname: Jha – volume: 60 start-page: 164 year: 2018 ident: 2023011920393665900_ref4 article-title: Safe laparoscopic cholecystectomy: a systematic review of bile duct injury prevention publication-title: Int J Surg doi: 10.1016/j.ijsu.2018.11.006 contributor: fullname: Graaf – volume: 191 start-page: 661 year: 2000 ident: 2023011920393665900_ref6 article-title: The "hidden cystic duct" syndrome and the infundibular technique of laparoscopic cholecystectomy – the danger of the false infundibulum publication-title: J Am Coll Surg doi: 10.1016/S1072-7515(00)00717-1 contributor: fullname: Strasberg – volume: 16 start-page: 30 year: 2021 ident: 2023011920393665900_ref2 article-title: 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy publication-title: World J Emerg Surg doi: 10.1186/s13017-021-00369-w contributor: fullname: Deangelis |
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