DOUBLE CYSTIC DUCT FOUND BY INTRAOPERATIVE CHOLANGIOGRAPHY IN LAPAROSCOPIC CHOLECYSTECTOMY

We report a rare case of double cystic duct in a 74-year-old woman. Th e patient complained of mild epigastric discomfort, and several stones were discovered by ultrasonography and computed tomography. Any anoma lies of the biliary tract were undetectable in the preoperative examin ations without direct cholangiography. Laparoscopic cholecystectomy wa s performed. After clipping the cystic duct close to the gallbladder, as usual, serial intraoperative cholangiogaphy was performed and unexp ectedly showed the inflow of contrast medium into the gallbladder via another cystic duct arising from the right hepatic duct, thus revealin g one gallbladder and two cystic ducts, one of which joined the common hepatic duct and the other the right hepatic duct. There was only one cystic artery that arose from the right hepatic artery and accompanie d the primary cystic duct to be distributed to the gallbladder. The ex istence of contrast medium in the resected specimen was confirmed by r adiography. No complications occurred during or after laparoscopic cho lecystectomy. This is the first report of double cystic duct found in laparoscopic cholecystectomy. We recommend routine preoperative or int raoperative cholangiography.