A K. Mathur, Praveen Mathur
Abstract: Bile duct injury is a recognized complication of laparoscopic cholecystectomy. Anomalous right posterior sectoral bile duct occurs in around 25 % of patients. Its drainage can occur into the gall bladder neck, cystic duct, common hepatic duct or rarely into left hepatic duct increasing the risk of injury during laparoscopic cholecystectomy. Sectoral bile duct injury is rare often missed during surgery or diagnosed late postoperatively but contributes to significant morbidity to the patient with multiple subsequent interventions and procedures (1). Herein, we describe 5 cases of isolated right posterior sectoral ducts encountered during laparoscopic cholecystectomy. In all cases the dissection of Calots triangle was difficult and stone impacted close to juncton of the aberrant duct with gall bladder or cystic duct. In 4 cases, the sectoral duct was joining cystic duct and was saved. In another case the sectoral duct was draining into the gallbladder neck, it was detected only after clipping and cutting of cystic duct below it was joined by sectoral duct. Patient needed conversion to open surgery and roux-en-y hepaticojejunostomy was done with the sectoral duct. Patient made uneventful recovery. This paper discusses strategies for prevention of such injuries along with the diagnostic and therapeutic challenges it offers.
Keywords: Cholecystectomy, Bile duct injury, Sectoral bile duct, Hepaticojejunostomy, Segmental Liver Resection