A Case of Gangrenous Cholecystitis with Double Cystic Duct

Ken Seshimo, Tetsuo Watanabe, Yosuke Tsunemitsu, Naoshi Mitsuoka and Yoko Tabuchi

Department of Surgery, Watanabe Hospital of Gastroenterology and Surgery

We report a rare case with double cystic duct of gallbladder in a 48-year-old man. The patient complained of vomiting and right hypochondrial pain. On admission, ultrasonography revealed wall thickness and several stones in the gallbladder. Preoperative endoscopic retrograde cholangiopancreatography showed 2 cystic ducts, 1 branching from the common bile duct and the other from the right hepatic duct. At laparotomy, the gallbladder and Calot's triangle were surrounded by thick multiple adhesions. With sharp and blunt dissection, the cystic duct branching from the common bile duct was first discovered. Subsequently, we discovered that there was another duct branching from the hepatic hilum. We performed intraoperative cholangiography by inserting the tube from the gallbladder neck, and were able to detect the double cystic duct and CBD stones. Following this procedure, we performed a cholecystectomy, choledocholithotomy and T-tube drainage. It was classified as an E type under Hisatsugu's classification. A double cystic duct is extremely rare. A search of the English literature showed only 12 previous reports. This case demonstrates the importance of being aware of the possibility of potential biliary variations to avoid biliary ductal injuries during surgery. We were able to perform open cholecystectomy safety. This case suggests that preoperative endoscopic retrograde cholangiopancreatography and intraoperative cholangiography are required to avoid complications during open cholecystectomy.

Key words
biliary anomaly, double cystic duct, gangrenous cholecystitis

Reprint requests
Ken Seshimo Department of Surgery, Watanabe Gastroenterological Hospital
539-5 Tamashima Uwanari, Kurashiki, 713-8101 JAPAN

Accepted
November 26, 2003

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