Harding Tim, Hannan Enda, Brosnan Conor, Duggan William, Ryan David, Stafford Anthony, Maguire Donal
Department of Surgery, St Michael's Hospital, Dublin, Ireland.
J Surg Case Rep. 2020 Jun 19;2020(6):rjaa161. doi: 10.1093/jscr/rjaa161. eCollection 2020 Jun.
We present a rare case of a duplicated cystic duct encountered during an elective laparoscopic cholecystectomy in a patient with biliary colic. Prompt recognition of an intraoperative bile leak followed by thorough examination and recognition of the source allowed for timely and appropriate management of the affected patient with a satisfactory post-operative outcome. Our case is unique by the lack of availability of intraoperative cholangiogram at the time of surgery, which posed a significant diagnostic and therapeutic challenge, and by how aberrant anatomy was confirmed intraoperatively by reviewing prior cardiac magnetic resonance imaging. Unremarkable preoperative imaging does not rule out the presence of abnormal anatomy. Early involvement of a specialist hepatobiliary surgeon is essential in an unexplained bile leak, with a low threshold in converting to an open procedure if there is difficulty in clearly deciphering anatomy.
我们报告了一例罕见病例，在一位患有胆绞痛的患者进行择期腹腔镜胆囊切除术时遇到了重复胆囊管。术中及时识别胆汁漏，随后进行全面检查并确定漏源，从而能够对受影响的患者进行及时且恰当的处理，术后结果令人满意。我们的病例具有独特性，一是手术时无法进行术中胆管造影，这带来了重大的诊断和治疗挑战；二是通过回顾之前的心脏磁共振成像在术中确认了异常解剖结构。术前影像学检查无异常并不能排除存在异常解剖结构的可能性。在不明原因的胆汁漏情况下，早期请肝胆外科专家介入至关重要，如果在清晰解读解剖结构方面存在困难，应果断转为开放手术。
