DIFFERENT ANATOMY OF EXTRAHEPATIC BILE DUCT IN PATIENTS WITH CALCULOUS CHOLECYSTITIS: CLINICAL OBSERVATIONS

Abstract

Summary. The aim of investigation – to get acquainted with the possibilities of variant anatomy of the extrahepatic bile ducts location.
 Results and their discussion. In our own practice, we observed two patients with the extrahepatic bile ducts atypical anatomy.
 Patient G. was operated because of chronic calculous cholecystitis. During laparoscopic cholecystectomy, we encountered the following situation: it was found that the gallbladder has a very short duct directly in the region of the portal of the liver. After dissection it was found that d. cysticus flows into the right hepatic duct. Timely establishment of this variant anatomy, which was achieved by careful dissection of the junction area d. cysticus and d. hepaticus dexter, allowed to prevent (in this case) wrong clipping of the right hepatic duct. In this example the possibility of timely establishing the presence of anatomical features of the extrahepatic bile ducts made it possible to prevent their damage.
 Patient K. was operated because of calculous cholecystitis, choledocholithiasis (without clinical and laboratory signs of mechanical jaundice). During laparoscopic cholecystectomy, it was established that the patient has variant anatomy of the extrahepatic bile ducts, when the right hepatic duct drains directly into the gallbladder. This anomaly was discovered after the separation of the gallbladder from its bed, as a result of which this duct was damaged. The access conversion was performed, the place of exit from the liver in the area of the gallbladder of the anomalous right hepatic duct was established. In order to restore the outflow of bile, a right-sided hepaticojejunostomy was performed on a Roux loop, external drainage of the choledoch according to Ker, drainage of the abdominal cavity.
 Conclusions. Although laparoscopic cholecystectomy is a standard routine operation, the variability of extrahepatic bile duct location should be considered.
 We consider it expedient during dissection in the area of the transition of the vesical duct to the hepaticocholedoch to carefully isolate all anatomical structures until their absolute identification.