Antonio Serafin Valero-Liñánaseravl@yahoo.es
, Toni I. Stoyanov
, Alba Sanchez-Gallego
, Elías Garcia-Grimaldo
, José Antonio Gonzalez-Masiá
, José Ignacio Miota de Llama
, Belén Conde-Inarejos
, Olga Luengo-Ballester
, Beatriz Aguado-Rodríguez
, Kaloyan T. Ivanov
and Pencho T. Tonchev
1 Department of General and Digestive Surgery, Spain
2 Department of General and Plastic Surgery, Ruse, Bulgaria
3 Departments of Surgical Propaedeutics, Pleven, Bulgaria
The variations of the cystic duct are so common that only 30% of all humans present the classical anatomical arrangement between the common bile duct (CBD), the cystic duct, and adjacent arteries. Thus, it could be considered that anomalies of the biliary tree are a rule rather than an exception. Duplication of the cystic duct, however, is a very uncommon anatomical finding. In the Department of General and Digestive Surgery of the University Hospital Complex Albacete, a 73-year-old patient was admitted with symptoms of cholangitis. He underwent emergency surgery that found exacerbated chronic cholecystitis and dilation of the CBD. Cholecystectomy was performed with identification of a double cystic duct that drained separately in the CBD and exploration of the last revealed cholangitis without choledocholithiasis. The postoperative period progressed favourably, proceeding to discharge from the hospital with Kehr drainage closed. In conclusion, we consider that the routine use of intraoperative cholangiography when there is suspicion of anatomical variations of the biliary tree is mandatory to rule out lesions or alterations thereof.
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1. Shivhare R, Sikora SS. Double cystic duct: a rare biliary anomaly encountered at laparoscopic cholecystectomy. J LaparoendoscAdv Surg Tech A. 2002;12(5):391-2.
2. Tsutsumi S, Hosouchi Y, ShimuraT, Asao T, Kojima T, Takenoshita SI, et al. Double cystic duct detected by endoscopic retrograde cholangiopancreatography and confirmed by intraoperative cholangiography in laparoscopic cholecystectomy: a case report. Hepatogastroenterology. 2000;47(35):1266-8.
3. Agha RA, Fowler AJ, Saeta A, Barai I, Rajmohan S, Orgill DP, et al. The SCARE Statement: Consensus-based surgical case report guidelines. Int J Surg.2016;34:180-6.
4. Salih AM, Kakamad FH, Mohammed SH, Salih RQ, Habibullah IJ, Muhialdeen AS, et al. Double cystic duct, a review of literature with report of a new case. Int J Surg Case Rep. 2017;38:146-8.
5. Otaibi W, Quach G, Burke B. Double cystic duct in a septated gallbladder. J Investig Med High Impact Case Rep. 2015;3(2):2324709615579105.
6. Blumgart LH, Hann LE. Surgical and radiologic anatomy of the liver and biliary tract, and pancreas. In: Blumgart LH, Fong Y, editors. Surgery of the liver and biliary tract. 3rd ed. London: WB Saunders; 2000. p. 18-20.
7. Görkem SB, Doğanay S, Kahriman G, Küçükaydın M, Coşkun A. Acute cholecystitis of a duplicated gallbladder with double cystic duct in a 10 year old boy. Balkan Med J. 2014;31(4):366-7.
8. Samnani SS, Ali A.”Y” variant of double cystic duct: incidental finding during laparoscopic cholecystectomy. Indian J Surg. 2015;77(Suppl 3):S1491.
9. Munie S, Nasser H, Go PH, Rosso K, Woodward A. Case report of a duplicated cystic duct: a unique challenge for the laparoscopic surgeon. Int J Surg Case Rep. 2019;56:78-81.
10. Fujii A, Hiraki M, Egawa N, Kono H, Ide T, Nojiri J, et al. Double cystic duct preoperatively diagnosed and successfully treated with laparoscopic cholecystectomy: a case report. Int J Surg Case Rep. 2017;37:102-5.