A Case of Obstructive Cholangitis of the Accessory Hepatic Duct Occurring 30 years after a Cholecystectomy

Abstract

  We reported a case which developed obstructive cholangitis of the accessory bile duct 30 years after undergoing a cholecystectomy. A 78-year-old male patient was admitted to the emergency department, presenting with a fever of 40 degrees Celsius with chills and abdominal pain. The patient's past medical history included a cholecystectomy performed approximately 30 years ago.
  Contrast-enhanced computed tomography (CT) and magnetic resonance cholangio-pancreatography (MRCP) findings led to a diagnosis of obstructive cholangitis associated with jaundice due to the obstruction of the accessory bile duct. This was possibly attributable to a ligation of the accessory bile duct which was injured during cholecystectomy. The intraoperative findings showed confluence of the dilated intrahepatic bile duct and the common bile duct in the vicinity of the cystic duct which was already resected. The accessory bile duct was ligated and resected at the confluence followed by right hepatic lobectomy. A histopathological examination of the resected specimen showed the cord-like, occluded area of the stenosed accessory bile duct with no neoplastic lesions. It should be noted that inflammation may occur in the accessory bile duct associated with difficult differentiation if cholecystitis develops concurrently due to gallstone incarceration in the neck of the gallbladder. Therefore, drip infusion cholangiography-CT and MRCP are required preoperatively for the sufficient visualization of direction of the bile ducts, and endoscopic retrograde cholangiography should also be performed if no satisfactory results are obtained from these imaging tests. It is important to ensure that the direction of the bile ducts in the individual segments is always confirmed before performing a cholecystectomy.