An anomaly of the extrahepatic biliary system

M. Hashmonai and D. Kopelman
Department of Surgery B, Rambam Medical Center, Haifa, Israel.

An anomaly of the extrahepatic biliary system is reported in which the common hepatic duct was found to enter the gallbladder, whereas the cystic duct drained the whole biliary system into the duodenum. Review of the literature revealed only eight previously reported similar cases. To ascertain such anatomy, a choledochal cyst and the Mirizzi syndrome must be excluded. In the past, the rarity of the configuration described herein led to transection of the common hepatic duct during cholecystectomy in most cases. The concomitant presence of other abdominal anomalies, as in our case, or severe inflammation in the porta hepatis should prompt suspicion of biliary anomalous anatomy. In that case, dissection of the gallbladder from the fundus downward will allow timely discovery of such an anomaly. Maintenance of continuity between the common hepatic duct and cystic-common biliary duct by preserving part of the gallbladder permits easy repair on a T tube.