A CASE OF GALLBLADDER AND COMMON BILE DUCT STONES WITH RARE UNNATURAL RUN OF THE BILE DUCT

Abstract

A 71-year-old man complaining of right hypochondralgia was referred to the hospital because gallbladder stone was pointed out at another hospital. There was slight tenderness in the right upper quadrant of the abdomen. Hematological studies showed increases in hepatic and billiary enzymes. Abdominal ultrasonography and CT scan revealed a stone in the gallbladder. Magnetic resonance cholangio-pancreatography (MRCP) showed a mild dilatation of the common bile duct and a filling defect in the lower bile duct probably due to a stone. With a diagnosis of gallbladder and common bile duct stones, a laparoscopic cholecystectomy, incision and lithotomy of the common bile duct, and C-tube drainage were performed. During surgery, when dissecting the cystic duct up to the common bile duct, the bile duct which runs toward the porta hepatis had been confluent and was thought to be the accessory hepatic duct. However, this uncommon bile duct had again joined with the right hepatic duct.
Although there are many variations in unnatural run of the biliary duct, this unnatural run of the bile duct which had arisen from the cystic duct to the right hepatic duct is rare. In this paper a case of gallbladder and common bile duct stones associated with this rare unnatural run of the bile duct is reported.