Iatrogenic injury of an aberrant right posterior sectoral bile duct

John Cantrell

doi:10.4102/sajr.v15i3.374

Abstract

A 34-year-old woman presented with a history of a previous laparoscopic cholecystectomy, followed within a few days by a formal laparotomy for a suspected bile duct injury. Approximately one week after the laparotomy, she developed a sinus on the anterior abdominal wall that was draining bile. She was then referred to our institution for further management. The earlier surgery was done at another hospital, and these details were not clear.  A CT scan, including a CT sinogram, was performed. The sinogram was done by inserting a catheter into the sinus and running in diluted contrast under gravity. CT images showed the sinus tract communicating with a collection in the gallbladder fossa, as well as contrast opacification of the segment 6 and 7 bile ducts. A week later, an endoscopic retrograde cholangiopancreatography (ERCP) examination was performed. This showed no filling of the right posterior sectoral ducts but normal opacification of the other ducts. These findings led to the diagnosis of an aberrant right posterior sectoral bile duct that was not identified prior to surgery and that was damaged at the time of laparoscopic cholecystectomy. This duct now drained into the gallbladder fossa, causing the collection and draining sinus.

Highlights

A CT scan, including a CT sinogram, was performed
A week later, an endoscopic retrograde cholangiopancreatography (ERCP) examination was performed. This showed no filling of the right posterior sectoral ducts but normal opacification of the other ducts (Figs 3a and b). These findings led to the diagnosis of an aberrant right posterior sectoral bile duct that was not identified prior to surgery and that was damaged at the time of laparoscopic cholecystectomy
Pericholecystic biliary anomalies that are often overlooked at the time of laparoscopic cholecystectomy include both aberrant ducts and accessory ducts such as Luschka’s duct anomaly.[1]

Summary

Introduction

A CT scan, including a CT sinogram, was performed. The sinogram was done by inserting a catheter into the sinus and running in diluted contrast under gravity. CT images showed the sinus tract communicating with a collection in the gallbladder fossa, as well as contrast opacification of the segment 6 and 7 bile ducts.

Results

Conclusion