Intraoperatively, we found that the CD drained into the right hepatic duct
rather than directly through the common bile duct, which is a very rare anatomic variation.
Vakili et al  noticed that caudate process duct drains into right hepatic duct
(85%) and left part of caudate lobe into left hepatic duct (93%).
The "normally" located gallbladder cystic duct entered the common bile duct, whereas the duplicate gallbladder cystic duct entered the right hepatic duct
E4###Separate left and right hepatic duct
09%) including 6 cases of common BDI, 2 cases of common hepatic duct injury, 1 case of right hepatic duct
injury, 1 case of accessory right hepatic duct
, 1 case of aberrant BDI 1 case of biliary stricture, 1 case of biliary duct perforation, 3 cases of hemobilia, and 4 cases of bile leakage.
21 type A--bile leak from cystic duct stump or gallbladder bed; type B--aberrant right hepatic duct
occlusion; type C--aberrant right hepatic duct
transection; type D--partial (<50%) transection of a major bile duct; and type E-->50% transection or complete transection of a major bile duct (further subclassified as E1-->2 cm from the confluence of the left and right hepatic ducts
; E2--<2 cm from confluence; E3--no common hepatic duct remnant with an intact hepatic duct confluence; E4--destruction of the hepatic duct confluence; and E5--aberrant right sectoral duct in conjunction with an injury to the common hepatic duct).
A cyst of 8 cm in segments 4 and 5 involved the hepatic confluence, with destruction of the right hepatic duct
and promoting a major biliary fistula with the left hepatic duct, confirmed by intra-operative transcystic cholangiography.
The commonest cause of malignant biliary obstruction is Klatskin tumor, defined as any tumor at the level of confluence of left and right hepatic duct
There was no conversion because of trocar insertion, diaphragmatic injury, right hepatic duct
injury, common bile duct calculi or retroperitoneal haematoma.
These anomalies, noted with increasing frequency, include the hepatocystic duct where the common hepatic or right hepatic duct
inserts into the gallbladder, choledochal cysts, stenosis and choledochocoele.
On comparing the above studies, the present study coincides with that of Flint and Lurje regarding the presence of accessory right hepatic duct
Surgical treatment was undertaken and consisted of a left hepatic lobectomy with resection of the common hepatic duct and common bile duct, followed by anastomosis to the right hepatic duct