Yıldız İhsan, Koca Yavuz Savaş, Kantar Sezayi
Department of General Surgery, Suleyman Demirel University Medical School, Isparta, Turkey.
Case Rep Surg. 2018 Jan 31;2018:1259561. doi: 10.1155/2018/1259561. eCollection 2018.
The anatomical variability of bile ducts can leave surgeons in very difficult conditions.Ultrasonography, computed tomography, magnetic resonance imaging (MRCP) and endoscopic imaging methods are used in diagnosis. In addition to conservative approaches, endoscopic procedures and laparoscopic or open surgical interventions may be necessary for treatment. In this article, we present a case of aberrant bile duct in left triangular ligament (appendix fibrosa hepatis), which is rarely seen.
We report the case of a 67-year-old female patient who was operated on due to dumping syndrome symptoms and hiatal hernia. There was a drainage of bile from the left side of the liver which was placed under the cardioesophageal junction. MRCP found bile esophageal in the left triangular ligament of the liver. Aberrant bile ducts were found in the left triangular ligament and ligated. The patient was discharged on the 7th day after operation.
The anatomical variability of bile ducts can leave surgeons in very difficult conditions. We recommend that the dissected left triangular ligament should be ligated for the aberrant bile duct, especially in female patient.
胆管的解剖变异会使外科医生处于非常困难的境地。超声、计算机断层扫描、磁共振成像（MRCP）和内镜成像方法用于诊断。除保守治疗方法外，内镜手术以及腹腔镜或开放手术干预可能是治疗所必需的。在本文中，我们呈现了一例罕见的左三角韧带（肝纤维附件）异常胆管病例。
我们报告了一名67岁女性患者的病例，该患者因倾倒综合征症状和食管裂孔疝接受手术。在位于食管贲门交界处下方的肝脏左侧有胆汁引流。MRCP发现肝脏左三角韧带内有胆汁进入食管。在左三角韧带内发现异常胆管并进行了结扎。患者术后第7天出院。
胆管的解剖变异会使外科医生处于非常困难的境地。我们建议，对于异常胆管，尤其是女性患者，应结扎解剖出的左三角韧带。
