VIDEO-LAPAROSCOPIC TREATMENT OF A SIZABLE CYST OF THE CYSTIC DUCT - ACASE-REPORT

A case of cystic dilation isolated from the cystic duct is described. The patient showed symptoms of chronic calculous cholecystitis; the ul trasonographic examination confirmed the clinical hypothesis and showe d a 1.3-cm calculus impacted in the infundibulum of the gallbladder. T he hepatic and biliary functions were normal. During surgery, the rout ine cholangiographic study showed a sizable cyst in the cystic canal, as well as an anomalous duct uniting the cyst to the right hepatic duc t. As for the rest of the extrahepatic biliary canal, as well as the i ntrahepatic canal, nothing abnormal was noticed. The videolaparoscopic treatment consisted of a ligature with a clip of the cystic duct and the anomalous duct plus en bloc resection of the cyst and the gallblad der. Histopathologic study showed it to be a benign cyst and chronic c alculous cholecystitis. It is important to establish the site of the c yst precisely before surgery, as the procedure should include its rese ction, since it could be the source of infection or development of lit hiasis and even malignant degeneration. There are two hypotheses for t he appearance of cysts in the biliary tract: congenital, due to a flaw in the multiplication of the cells that will form the biliary tract d uring the fetal life, and by aggression by pancreatic juice flowing ba ck to the main biliary canal. The congenital origin seems to be the hy pothesis that better explains the appearance of the cyst in the case d escribed here, considering that the backflow of the pancreatic juice c ould hardly have occurred because of the anatomy as observed: the none xistence of the common biliary-pancreatic canal and the valvular mecha nism, present in the cystic canal, between the cyst itself and the con fluence of the cystic canal into the main biliary canal, in addition t o the anomalous biliary canal communicating the cyst to the right intr ahepatic canal.