Double hepatic duct associated with anomalous pancreatobiliary ductal junction

Abstract

A 58-year-old woman was admitted to a local clinic with the complaint of right subcostal and back pain in October 2002. Wall thickening and a polypoid lesion of the gallbladder were detected by abdominal ultrasonography. She was referred to this hospital for further evaluation of the wall thickening and gallbladder lesion. Abdominal ultrasonography showed a two-chamber gallbladder, the wall of which was thickened and yielded small strong echos, containing a broad-based polypoid lesion 12 mm in diameter. Endoscopic retrograde cholangiography was performed, and revealed a double hepatic duct and an anomalous pancreaticobiliary ductal junction (Fig. 1). The right side hepatic duct joined with the cystic duct, draining into the common bile duct through a narrow segment. Preoperative computed tomography revealed no elevated mucosal lesion in the gallbladder. We performed open cholecystectomy because of suspected gallbladder cancer and to prevent injury to the narrow segment of the biliary duct when performing cholecystectomy from the fundus [1]. Intraoperative cholangiography also showed a double hepatic duct. The resected gallbladder showed hyperplasia with focal regenerative atypia of the mucosa but no carcinoma. The polypoid lesion detected preoperatively was a constriction of the gallbladder. The postoperative course was uneventful. The patient had no right subcostal pain after discharge.