Iwasaki Toshimitsu, Takeyama Yoshifumi, Yoshida Yuta, Kawaguchi Kohei, Matsumoto Masataka, Murase Takaaki, Kamei Keiko, Takebe Atsushi, Matsumoto Ippei, Nakai Takuya
Department of Surgery, Kindai University, Faculty of Medicine, Japan.
Department of Surgery, Kindai University, Faculty of Medicine, Japan.
Int J Surg Case Rep. 2019;61:115-118. doi: 10.1016/j.ijscr.2019.07.013. Epub 2019 Jul 19.
Aberrant subvesical bile ducts are rare structural anomaly located in the peri-hepatic gallbladder fossa. This duct poses the risk for intraoperative bile duct injury resulting in clinically relevant bile leakage.
Aberrant subvesical bile duct was detected by preoperative magnetic resonance cholangiopancreatography in a 52-year old woman with gallbladder polypoid tumor harboring the risk to be gallbladder cancer. During open cholecystectomy with full thickness dissection, the aberrant duct was identified by intraoperative fluorescent cholangiography (IFC), and dissected safely.
Aberrant subvesical bile ducts are mostly found unexpectedly as intra and/or postoperative bile leakage, and remain an important cause of bile duct injuries after laparoscopic cholecystectomy. IFC, which offers real-time imaging of biliary anatomy, has a potential to overcome these problems.
We performed cholecystectomy by using IFC to identify the aberrant subvesical bile duct. To the best of our knowledge, this is the first report showing the fluorescence image of an aberrant subvesical bile duct in a state of nature.
膀胱下迷走胆管是一种罕见的结构异常，位于肝周胆囊窝。该胆管存在术中胆管损伤风险，可导致具有临床意义的胆漏。
一名52岁患有胆囊息肉样肿瘤且有胆囊癌风险的女性，术前磁共振胰胆管造影检测出膀胱下迷走胆管。在进行全层解剖的开腹胆囊切除术中，术中荧光胆管造影（IFC）识别出该迷走胆管，并安全地进行了分离。
膀胱下迷走胆管大多在术中及/或术后胆漏时意外发现，仍是腹腔镜胆囊切除术后胆管损伤的重要原因。IFC可提供胆道解剖的实时成像，有潜力克服这些问题。
我们通过使用IFC识别膀胱下迷走胆管进行了胆囊切除术。据我们所知，这是第一份展示膀胱下迷走胆管自然状态下荧光图像的报告。
