Intrahepatic gallbladder and cystic duct maljunction presenting with intermittent right hepatic ductal obstruction and recurrent cholangitis: a case report

Abstract

The patient is a 15-year-old male. He has had recurrent abdominal pain for almost 10 years. Blood tests revealed elevated hepatobiliary enzymes and inflammatory reactions, but the cause could not be found. Abdominal ultrasonography performed immediately after the onset of abdominal pain revealed enlarged gallbladder, stenosis of the adjacent right hepatic duct, and dilatation of the intrahepatic bile duct. Magnetic resonance cholangiopancreatography revealed intrahepatic gallbladder and cystic duct maljunction. Endoscopic retrograde cholangiopancreatography showed that the cystic duct joined near the bifurcation of anterior and posterior branch, and that the gallbladder caused compression and stenosis of the right hepatic duct. It was revealed that biliary congestion due to obstruction of hepatic duct more centrally than at the junction. Laparoscopic cholecystectomy was performed. Cholangiography with indocyanine green fluorescence was performed to ensure the safety.