Case of Abnormal Biliary Distribution in Which Intraoperative Endoscopy of Naso-biliary Drainage Tube was Informative in Carrying out Laparoscopic Cholecystectomy

Abstract

For a patient having cholelithiasis complicated with abnormality in the intrahepatic external biliary distribution, we placed an endoscopic naso-biliary drainage tube (ENBDT) and performed laparoscopic cholecystectomy (LC). This case is reported here. The subject was a 47-year-old woman with cholelithiasis. Preoperative ERCP revealed abnormalities in the intra and extra hepatic biliary distribution. Cholangiography demonstrated that the branch in the region posterior to the right hepatic duct bifurcated independently from the dorsal side of the common bile duct and the cystic duct bifurcated from the branch in the right posterior region. Moreover, it was a special type in which the anterior branch and the posterior branch in the right hepatic duct flowed together. Following drip infusion cholangiography (DIC), helical CT was conducted and the biliatry distribution was confirmed using the 3-dimensional biliary images (3D-CT). The ENBDT was placed one day prior to surgery. During LC, while cholangiography was performed using the ENBDT, the relationship between the surgical field and the cholangiograms or 3D-CT images was confirmed, and the surgery then proceeded. Cholangiography using ENBDT was effective for indentification of the bile duct and enabled completion of LC without damage to the bile duce.