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
. Calots triangle is an important landmark for identifying the cystic duct and cystic artery during cholecystectomy so that damage to extrahepatic biliary tree can be avoided.
Repeat ERCP findings suggested benign ectasia of the common hepatic duct
as the presence of the stone in the cystic duct was not found to be occluding the bile duct.
An abdominal ultrasound showed multiple gallstones, and common hepatic duct
and intrahepatic biliary tree dilatation.
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
Intraoperative cholangiogram revealed normal filling of the intrahepatic ducts, common hepatic duct
, common bile duct, and cystic duct with normal flow into the duodenum.
With loupe, we finished hepatic artery anastomosis and adopted end-to-end anastomosis of right hepatic duct to common hepatic duct
, or Roux-en-Y choledochojejunostomy.
( No = 10) (ii).Clipping of common Hepatic duct
Another interesting aspect of this case is the presence of a chronically distended gallbladder (gallbladder hydrops), associated with extrinsic compression of the common hepatic duct
by an impacted stone in the infundibulum (Mirizzi syndrome type I) (8).
Malignant biliary obstruction is usually secondary to pancreatic adenocarcinoma or is due to cholangiocarcinoma of the common bile, or common hepatic duct
(including the bifurcation, collectively called hilar), or the intrahepatic bile ducts (peripheral).
4): 1) The hepatic portal vein and the hepatic artery proper and / or its accessories; the common hepatic duct
exits, the hepatic artery proper forward and to the left, the bile duct forward and to the right, the hepatic portal vein behind and in the middle of the inferior hepatic pedicle.