Abstract
A 24-year-old woman was placed on oral bile salt maintenance therapy due to cholecystolithiasis at another hospital because of right hypochondralgia and back pain in April 1992. However, the pain did not disappear, and she was admitted to our hospital on April 12, 1993. Many strong echoes with acoustic shadows and comet signs were observed on abdominal ultrasonography. Drip infusion cholangiogram (DIC) showed many small stones and the wall thickness of the gallbladder, but the cystic and common bile duct were not identified. Three dimensional reconstruction with spiral CT scanning after DIC indicated the cystic duct opening into an accessory hepatic duct.Laparoscopic cholecystectomy was done, and the confluence pattern was confirmed with intraoperative cholangiography.Spiral CT scanning was useful for preoperative examination, and intraoperative cholangiography was also helpful for avoiding damage to the bile duct.
