CLINICAL CASE OF RARE EXTRAHEPATIC BILE DUCT ANOMALY

This article describes a clinical case of a rare anomaly of the extrahepatic bile ducts – the confluence of the cystic duct into the right hepatic duct with the intraoperative intersection of the right hepatic duct during the laparoscopic cholecystectomy. A conversion with the subsequent formation of Roux-en-Y hepaticojejunostomy with the right hepatic duct has been produced to the patient. Nowadays there is a small amount of literature data describing the confluence of the cystic duct into the right hepatic duct. That kind of variation of extrahepatic anomaly of the bile duct occurs in 0,1-2,3% cases and, according to some authors, is one of the most insidious anatomical variants, that is able to lead to intraoperative complications. In addition, in cases of destructive forms of acute cholecystitis, the infiltration in the bladder neck region can reach 8.0-40.7% of cases. It makes the manipulation during the operation much more difficult and also slightly modifies the anatomy of tubular structures in the Kalo triangle area. In the presented clinical observation, the noticeable scar-inflammatory process modified the anatomy of the extrahepatic bile ducts that that had already been atypical. Althought it made the dissection in the area of the Kalo triangle more complicated. This case shows the possible tactics of patient management when the non-standard intraoperative situations occurs in real clinical practice.