Notice of the Cystohepatic Ducts in Cholecystectomy: A Report with Review of the literatures

A 74-year-old man presented with epigastralgia and was diagnosed as having cholelithiasis. Endoscopic retrograde cholangiopancreatography (ERCP) initially visualized the cystic duct with the Heister valve from the common bile duct, and then two intra-hepatic biliary ducts of segment 5 (B5) were visualized from the neck of the gallbladder. There was a contrast medium filling defect in B5, which was considered to be due to an incarcerated stone. Magnetic resonance cholangiopancreatography (MRCP) and three-dimensional computed tomography (CT) cholangiography showed similar findings, suggesting that the patient had a biliary anomaly of the cystohepatic duct in which two intrahepatic bile ducts (B5) flowed into the neck of the gallbladder and a stone incarcerated in the neck of the gallbladder. At surgery, during mobilization of the gallbladder, there was a thick string between the liver and the gallbladder, and this was considered to be the junction of B5 with the gallbladder. Therefore, the neck of the gallbladder was cut, and an incarcerated stone 10 mm in diameter was removed. Intraoperative cholangiography revealed that the cystohepatic ducts were preserved. The postoperative course was uneventful and there was no bile leakage or liver dysfunction. Although cystohepatic duct is a rare biliary anomaly, the surgeon should be alert for its possible presence during cholecystectomy. When cholecystectomy is scheduled, more than one preoperative examination by three-dimensional CT cholangiography, MRCP or ERCP should be performed, and the surgeon should be careful not to overlook any biliary anomaly.