A Resected Case of Carcinoma of the Papilla of Vater Associated with Abnormality of the Bile Duct from the Caudate Lobe

Ryuichi Kawahara, Takenori Sakai, Satoshi Furukawa, Hiroto Ishikawa, Hisafumi Kinoshita, Shigeaki Aoyagi and Kazuo Shirouzu

Department of Surgery, Kurume University School of Medicine

Care should be taken in the anomalous course of extrahepatic bile duct as a cause of intraoperative bile duct injury. We report a case of carcinoma resection of the papilla of Vater associated with a low-junction caudate lobe duct with the common bile duct, distal to the union of the left and right hepatic ducts. A 64-year-old man was diagnosed with carcinoma of the papilla of Vater on CT and upper gastrointestinal endoscopy and admitted for surgery was found in cholangiography to have a long accessory hepatic duct from the common bile duct the vicinity of the left hepatic duct, leading to a diagnosis of low-junction caudate lobe duct. During pancreaticoduodenectomy surgery, we found a caudate lobe duct 2 mm in diameter extending from the left side of the common bile duct the liver. Postoperative CT showed no dilation of the caudate lobe duct, so he was discharged. An aberrant bile duct is important as a cause of intraoperative injury. Studies have reported that an aberrant bile duct without double communication must not be ligated, and that a bile duct more than 2 mm in diameter must be reconstructed. This case highlights the need to note the presence of a low-junction caudate lobe duct and to carefully evaluate preoperative images.

Key words
carcinoma of the papilla of Vater, accessory hepatic duct

Reprint requests
Ryuichi Kawahara Department of Surgery, Kurume University School of Medicine
67 Asahi-machi, Kurume, 830-0011 JAPAN

Accepted
February 20, 2008

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