PP 71. An Aberrant Right Accessory Hepatic Duct as a Cause of Iatrogenic Bile Leak: A Case Report
N. Samuel, V. Proctor, F. Mazari, M. Hanif Shiwani
19:18 - 19:22h
at Lanchid Room
Categories: Hepatobiliary and Pancreatic Surgery, Poster Session
Session: Poster (P5) - Hepatobiliary & Pancreatic Surgery
Background
The occurrence of Accessory Right Hepatic Duct(ARHD) is rare. We report on one such case identified intra-operatively and its learning implications.
Material and Methods
Case Presentation: A 27-year-old woman presented with signs and symptoms suggestive of Acute Cholecystitis and was treated with antibiotics; USS demonstrated multiple gall stones. Patient subsequently developed pancreatitis. An MRCP was done which showed multiple gall stones with no ductal dilatation. Laparoscopic cholecystectomy was planned as an urgent intervention. Intraoperatively, bile leak from an indeterminate site was encountered during Callot's triangle dissection. Cystic duct was isolated and intra-operative cholangiogram performed which demonstrated a short cystic duct arising from ARHD. The surgery was converted to open; iatrogenic bile leak from ARHD was identified and managed with a T-tube placement that was later removed. Retrospective review of pre-op MRCP did reveal the ARHD.
Result
Discussion: Although laparoscopic cholecystectomy is considered a safe procedure, commonly performed by trainees; it does carry its risks especially bile duct injury with its associated morbidity. The incidence of ARHD is low; however variation in the extra hepatic biliary system is common and could contribute to the higher incidence of bile duct injuries seen in laparoscopic procedures.
Conclusion
Despite advantages conferred by pre-op imaging, sound knowledge of extra hepatic biliary anatomy is a pre-requisite to anticipate and/or avert injury to the biliary system. To detect such injuries, trainees have to be taught intra-operative cholangiogram techniques and when indicated open surgical competence gained, to prevent further damage.
