D'Angelo Tommaso, Racchiusa Sergio, Mazziotti Silvio, Cicero Giuseppe
Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino", Messina, Italy.
Am J Case Rep. 2017 Mar 9;18:242-245. doi: 10.12659/ajcr.902620.
BACKGROUND MR cholangiopancreatography is widely performed before laparoscopic cholecystectomy to rule out choledocholithiasis and to avoid iatrogenic injuries that may be related to the high frequency of anatomical variations of the biliary tree. Although most of these variants have already been demonstrated surgically and by endoscopic retrograde cholangiopancreatography and CT cholangiography, there are no references in which MR cholangiopancreatography has shown a cystic duct draining into the right hepatic biliary duct. CASE REPORT A 51-year-old woman with a history of recurrent abdominal pain underwent an abdominal ultrasound in an outside center, which revealed gallbladder cholelithiasis. In this patient, an MR cholangiopancreatography was performed and the laboratory data were obtained. Laboratory findings showed only a mild increase of cholestasis. MRCP did not reveal significant dilatation of intra- or extrahepatic biliary ducts, while the cystic duct showed an atypical insertion, draining directly into the right hepatic duct. CONCLUSIONS To avoid unintentional bile duct injuries, MRCP evaluation of the biliary anatomy is particularly important for pre-operative evaluation of patients undergoing laparoscopic cholecystectomy. In particular, in the case we describe, the right hepatic duct might have been mistaken for the cystic duct, with potentially severe surgical complications and clinical consequences.
磁共振胰胆管造影（MR cholangiopancreatography，MRCP）在腹腔镜胆囊切除术之前广泛应用，以排除胆总管结石，并避免可能与胆管树解剖变异高发生率相关的医源性损伤。尽管这些变异中的大多数已通过手术、内镜逆行胰胆管造影及CT胆管造影得到证实，但尚无关于MRCP显示胆囊管汇入右肝胆管的相关报道。病例报告：一名有反复腹痛病史的51岁女性在外院接受腹部超声检查，结果显示胆囊结石。对该患者进行了MRCP检查并获取了实验室数据。实验室检查结果仅显示胆汁淤积轻度升高。MRCP未显示肝内或肝外胆管有明显扩张，而胆囊管显示出非典型的汇入方式，直接汇入右肝管。结论：为避免无意的胆管损伤，对于接受腹腔镜胆囊切除术的患者，术前通过MRCP评估胆管解剖结构尤为重要。特别是在我们所描述的病例中，右肝管可能会被误认为是胆囊管，从而可能导致严重的手术并发症和临床后果。
