Background: Rapid development and broad implementation of modern imaging methods and diagnostic techniques have greatly contributed to more precise appreciation of the anomalous conditions and pathologies of the extra...Background: Rapid development and broad implementation of modern imaging methods and diagnostic techniques have greatly contributed to more precise appreciation of the anomalous conditions and pathologies of the extrahepatic biliary system—one of the parts of the human body characterized with significant anatomical variability. Case Report: A 73-year-old female patient was admitted to The First Medical Center of Tbilisi with complaints of pain and a feeling of heaviness in the right hypochondrium, fever (38ºC), nausea, weakness, jaundice. Abdominal ultrasound revealed an enlarged gallbladder with thickened walls and a large stone incarcerated in the gallbladder neck. The diameter of the CBD was increased up to 4 cm, and large size stones present within the lumen. A CT scan has also revealed a cholecysto-duodenal fistula. Open cholecystectomy was decided as a treatment of choice. Intraoperatively was found a fistula between the fundus of the gallbladder and the duodenum, a gallbladder with thickened walls, and stones wedged into the neck, a common bile duct of significantly enlarged diameter (4 cm) with large size stones, and an accessory small diameter duct between the gallbladder and the CBD. After choledochotomy, 4 × 2 cm and 3 × 2 cm size stones were removed from CBD. During cholecystectomy, the Luschka duct was found within the gallbladder bed. Conclusion: We report on a rare case of anomaly presented in the form of an accessory bile duct between the gallbladder and the common bile duct, as well as with an accessory duct of Luschka. Additionally, significantly enlarged extrahepatic bile ducts with giant intraductal stones and cholecystoduodenal fistula were revealed. The combination of these pathologies and anomalies is extremely rare.展开更多
文摘Background: Rapid development and broad implementation of modern imaging methods and diagnostic techniques have greatly contributed to more precise appreciation of the anomalous conditions and pathologies of the extrahepatic biliary system—one of the parts of the human body characterized with significant anatomical variability. Case Report: A 73-year-old female patient was admitted to The First Medical Center of Tbilisi with complaints of pain and a feeling of heaviness in the right hypochondrium, fever (38ºC), nausea, weakness, jaundice. Abdominal ultrasound revealed an enlarged gallbladder with thickened walls and a large stone incarcerated in the gallbladder neck. The diameter of the CBD was increased up to 4 cm, and large size stones present within the lumen. A CT scan has also revealed a cholecysto-duodenal fistula. Open cholecystectomy was decided as a treatment of choice. Intraoperatively was found a fistula between the fundus of the gallbladder and the duodenum, a gallbladder with thickened walls, and stones wedged into the neck, a common bile duct of significantly enlarged diameter (4 cm) with large size stones, and an accessory small diameter duct between the gallbladder and the CBD. After choledochotomy, 4 × 2 cm and 3 × 2 cm size stones were removed from CBD. During cholecystectomy, the Luschka duct was found within the gallbladder bed. Conclusion: We report on a rare case of anomaly presented in the form of an accessory bile duct between the gallbladder and the common bile duct, as well as with an accessory duct of Luschka. Additionally, significantly enlarged extrahepatic bile ducts with giant intraductal stones and cholecystoduodenal fistula were revealed. The combination of these pathologies and anomalies is extremely rare.
