Clinical Figure and Problems in Cholecystectomy of Septal Structure in the Patients with Low Junction of the Cystic Duct

Nobuhiko Ueda, Ichiro Konishi, Teisuke Hirono, Hideaki Nezuka, Yutaka Yoshimitsu, Nagayoshi Ohta, Naotaka Kadoya

Department of Surgery, Toyama City Hospital

Twenty-six patients with low junction of the cystic duct experienced in our department during the past 7 years and 6 months were analyzed to elucidate the clinical fingure and problems in cholecystectomy of septal structure between the cystic duct and the common bile duct. In 23 of 26 patients, excluding 3 patients with low junction at the right side wall, the cystic duct revolved around the posterior wall of the common bile duct. There was no patient with low junction at the anterior wall or revolution of the cystic duct around the anterior wall. In 21 patients assessed by cholangiography after cholecystectomy, the spiral portion of the cystic duct was resected, but the septal structure remained as it was. Pathological findings of septal structutre in 3 patients revealed complete disappearance of normal wall structure except for a little atrophic muscle-fiber remnant just below the epithelium of both the cystic duct and the common bile duct. Hard collagen fiber proliferating secondarily had infiltrated, so both walls of the cystic duct and the common bile duct were united in a body. In cholecystectomy of these patients, preparation of the cystic duct must be limited at the portion of the spiral structure in cholangiography, and it is necessary to recognize that more excessive preparation causes bile duct injury.

Key words
low junction of cystic duct, septal structure, spiral structure of cystic duct, revolution of cystic duct, bile duct injury

Reprint requests
Nobuhiko Ueda Department of Surgery, Toyama City Hospital
292 Imaizumi Toyama, 939 JAPAN

Accepted
April 5, 1995

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