Department of Pediatric Surgery, Mashhad University of Medical Sciences, Mashhad, Iran.
Master of Science in Environmental Health Engineering, Mashhad University of Medical Sciences, Mashhad, Iran.
Fellowship of Pediatric Surgery, Mashhad University of Medical Sciences, Mashhad, Iran.
Introduction: Biliary tract injury is a major complication of laparoscopic cholecystectomywhich can be very challenging. But, the important part is to know the accurate anatomy of the ducts and site of the injury before any surgical attempt for ligation or repair. In this case a disaster might happen if we do not consider biliary anatomical abnormality as the main issue.
In this case, there was an additional duct originating from the right hepatic lobe and inserting directly to the common bile duct (CBD) along with the right hepatic duct. The injury to this branch led to biloma secretion from two tearing sites, one proximal to the branch and another distal of the branch adjacent to CBD, during laparoscopic cholecystectomy.
There are numerous anatomic variations in the biliary tract, so according to this case we highly recommend to assay the exact anatomy before any intervention by means of Magnetic resonance cholangiopancreatography (MRCP) or intraoperative cholangiography.