A rare case of atypical accessory bile duct: Luschka

Abstract

A 56-year-old male patient was admitted to our hospital with indigestion and abdominal bloating after eating. During routine surgery, a cystic artery, cystic duct, and an additional second duct were detected in the area of the Calot’s triangle. Considering that this channel is the accessory bile duct entering the gallbladder during dissection, this structure, cystic duct and cystic artery were double clipped and cholecystectomy was completed. Bile duct injury is a serious complication of laparoscopic cholecystectomy (LC). Bile leakage from accessory duct of Luschka is very rare. Anomalies of the bile ducts are common due to complex embryological stages of development. We wanted to share the presence of the atypical localized luschka canal that we encountered during gallbladder surgery. In our case, during the dissection of the Calot’s triangle, luschka was considered the main bile duct first, and after extensive dissection, it was concluded that this structure was luschka. During laparoscopic cholecystectomy operations, we recommend that the cystic artery and Canal be clipped after extensive dissection of the Calot’s triangle or even the hepatic triangle in experienced hands

Keywords

• Anomalies of the biliary tract
• Cholecystectomy
• Accessory Luschka channel

References

1. Senapathi A, Wolfe JH. Accessory cystic duct -an operative hazard. J R SocMed 1984; 77: 845–6.
2. Spanos CP, Syrakos T. Bile leaks from the duct of Luschka [subvesical duct]: a review. Langenbeck’s Arch Surg 2006; 391: 441-7.
3. Parampalli U, Helme S, Asal G, et al. Sinha Accessory cystic duct identification in laparoscopic cholecystectomy Grand Rounds 2008; 8: 40-2.
4. Aoki T, Imamura H, Sakamoto Y, et al. Bile duct of Luschka connecting with the cystohepaticduct: The importance of cholangio graphy during surgery. Am J Roentgenol 2003; 180: 694-6.
5. Frakes JT, Bradley SJ. Endoscopic stent placement for biliary leak from an accessory duct of Luchska after laparoscopic cholecystectomy. Gastrointest Endosc. 1993; 39: 90-2.
6. Strasberg SM, Hetl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopy cholecystectomy. J AmCollSurg. 1995; 180: 101-25
7. Russell JC, Walsh SJ, Mattie AS, et al. Bile duct injuries 1989-1993. ArchSurg. 1996; 131: 382-8
8. Prat F, Pelletier G, Ponchon T, et al. What role can endoscopy play in the management of biliary complications after laparoscopic cholecystectomy? Endoscopy 1997; 29: 341-8. 21.

9. Mergener K, Strobel JC, Suhocki P, et al. The role of ERCP in the diagnosis and management of accessory bile duct leaks after cholecystectomy. Gastrointest Endosc 1999; 50: 527-31.
10. Stewart L, Way LW. Laparoscopic bile ductinjuries: timing of surgical repair does not influence success rate. A multi variate analysis of factors influencing surgical outcomes. HPB [Oxford] 2009; 11: 516–22.
11. Bektas H, Schrem H, Winny M, et al. Surgical treatment and outcome of iatrogenic bile duct lesions after cholecystectomy and the impact of different clinical classification systems. Br J Surg 2007; 94: 1119- 27.