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      Case report of a duplicated cystic duct: A unique challenge for the laparoscopic surgeon

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          Highlights

          • Double cystic ducts with a single gallbladder is exceedingly rare.

          • Diagnosis of this anatomic variant is most commonly made intraoperatively.

          • Knowledge of biliary aberancies is crucial to preventing bile duct injury.

          • IOC should be utilized to elucidate biliary anatomy when unclear.

          Abstract

          Introduction

          Anatomical variants of the extrahepatic biliary tree are numerous, adding significantly to the risk of bile duct injury during cholecystectomy, especially when laparoscopic approach is employed. Duplicated cystic ducts draining a single gallbladder are extremely rare.

          Presentation of case

          A 34-year-old female presented with signs and symptoms of acute cholecystitis which was confirmed on imaging. She was found to have an accessory cystic duct on laparoscopic cholecystectomy requiring conversion to open laparotomy with intraoperative cholangiogram to delineate the anatomy.

          Discussion

          In the English literature, there has been 20 reported cases of double cystic duct with a single gallbladder. Most of these cases were diagnosed intraoperatively despite the completion of a preoperative endoscopic retrograde cholangiopancreatography in a few of these patients.

          Conclusion

          The limited success of preoperative biliary tract imaging in demonstrating anatomic aberrancies prior to cholecystectomy clearly highlights the importance of maintaining constant vigilance for even the slightest anatomic abnormality at operation. Any uncertainty or concern for ductal injury mandates immediate operative cholangiogram with cannulation of all structures in question.

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          Most cited references 16

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          The SCARE Statement: Consensus-based surgical case report guidelines.

          Case reports have been a long held tradition within the surgical literature. Reporting guidelines can improve transparency and reporting quality. However, recent consensus-based guidelines for case reports (CARE) are not surgically focused. Our objective was to develop surgical case report guidelines.
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            Double cystic duct.

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              Double cystic duct found by intraoperative cholangiography in laparoscopic cholecystectomy.

              We report a rare case of double cystic duct in a 74-year-old woman. The patient complained of mild epigastric discomfort, and several stones were discovered by ultrasonography and computed tomography. Any anomalies of the biliary tract were undetectable in the preoperative examinations without direct cholangiography. Laparoscopic cholecystectomy was performed. After clipping the cystic duct close to the gallbladder, as usual, serial intraoperative cholangiography was performed and unexpectedly showed the inflow of contrast medium into the gallbladder via another cystic duct arising from the right hepatic duct, thus revealing one gallbladder and two cystic ducts, one of which joined the common hepatic duct and the other the right hepatic duct. There was only one cystic artery that arose from the right hepatic artery and accompanied the primary cystic duct to be distributed to the gallbladder. The existence of contrast medium in the resected specimen was confirmed by radiography. No complications occurred during or after laparoscopic cholecystectomy. This is the first report of double cystic duct found in laparoscopic cholecystectomy. We recommend routine preoperative or intraoperative cholangiography.
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                Author and article information

                Contributors
                Journal
                Int J Surg Case Rep
                Int J Surg Case Rep
                International Journal of Surgery Case Reports
                Elsevier
                2210-2612
                28 February 2019
                2019
                28 February 2019
                : 56
                : 78-81
                Affiliations
                [a ]Department of Surgery/Division of Trauma and Acute Care Surgery, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA
                [b ]Department of Surgery, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA
                [c ]Department of Cardiothoracic Surgery, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
                [d ]Department of Surgical Oncology, Banner MD Anderson, 14416 W Meeker Blvd, Sun City West, AZ, 85375, USA
                Author notes
                [* ]Corresponding author. hnasser2@ 123456hfhs.org
                Article
                S2210-2612(19)30091-4
                10.1016/j.ijscr.2019.02.030
                6407078
                30851627
                © 2019 The Authors

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

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