ABSENCE OF CHOLEDOCHUS: AN EXCEPTIONAL ABNORMALY OF THE BILIARY TRACT

Aims Demonstrate an uncommon anatomic variation in biliary anatomy

Methods Use of imaging techniques and ERCP

Results 77-year-old patient with acute cholangitis. In the imaging study, a variant of normality is detected: right and left hepatic ducts converge at the distal intrapancreatic level with the consequent absence of a common hepatic duct. Likewise, the cystic duct has a very low implantation, in the same region of confluence. A 5mm stone was observed in the cystic duct and another in the duct confluence area. ERCP was performed with removal of the impacted stone at the suprapapillary level. On injecting contrast, cystic and what appears to be choledochus, repleniced. Contrast reflux into a third duct, suspecting a malformation of the choledochus insertion. It was not possible to extract the lithiasis located in cystic, so a double pigtail plastic stent was placed in the gallbladder. He was readmitted for a new episode of cholangitis. A second ERCP is performed: spontaneous migration of the cystic stent. At 7-8mm from the papilla, confluence of right and left hepatic ducts was observed that cross between them: the right goes to the left and the left goes to the right, with the absence of common bile ducts and choledochus. Cystic with obstructive lithiasis implanted about 5-6 mm from the bifurcation in the left hepatic duct.

Fig. 1

Conclusions Anatomical variants of the bile ducts are frequent, although the absence of choledochus is exceptional. Their knowledge is of the utmost importance during invasive bile duct procedures to avoid incidental bile duct injury.

Publication History

Article published online:
14 April 2022