The metal clip partially occluded lumen of the common hepatic duct
just below the confluence, which was the reason why the patient had not developed jaundice immediately.
Ten cases were converted to open surgery (6 cases of common BDI, 2 of common hepatic duct
injury, 1 of right hepatic duct injury, and 1 of accessory right hepatic duct).
Calots triangle is also known as cholecystohepatic triangle bounded above by inferior surface of right lobe of liver, laterally by the cystic duct, gallbladder and medially by the common hepatic duct
Reasons for conversion to open surgery included bleeding from avulsion of cystic artery (n=2), difficulty in controlling oozing of blood from liver bed (n=1), cholecystoduodenal fistula (n=1), adhesions/difficult anatomy at Calot's triangle (n=1), cystic duct avulsion (n=1) and common hepatic duct
2-3) It occurs when the common hepatic duct
becomes obstructed due to extrinsic compression from an impacted gallstone in the cystic duct or the neck of the gallbladder.
Complications included bleeding from cystic artery (n=1) and injury to common hepatic duct
Magnetic resonance i maging (MRI) of the abdomen with cholangiographic reconstruction showed an isolated stricture in the common hepatic duct
close to the junction of the right and left hepatic ducts (Fig.
Common hepatic duct
formed by the junction of Right and Left hepatic ducts.
The reasons for conversion were bleeding from cystic artery (n=1), difficulty in controlling oozing from liver bed due to improper functioning of insufflators (n=1), and hole in common hepatic duct
( CHD ) (n=1) during dissection of Calot's triangle in a case of acute cholecystitis in which laparoscopic cholecystectomy was completed and T-tube was placed laparoscopically.
Initial labs revealed elevated LFTs; however, a CT of the abdomen with contrast medium reported a normal liver and pancreas without specific common duct dilatation and only minimal ductal prominence at the common 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.
An unusual presentation of gall stones within Hartmann's pouch causes obstruction of common hepatic duct
by extrinsic compression, a phenomenon known as Mirizzi syndrome.