INADVERTENT LIGATION OF THE ABERRANT RIGHT HEPATIC DUCT AT CHOLECYSTECTOMY - RADIOLOGIC-DIAGNOSIS AND THERAPY

Aberrant right hepatic ducts are the most common biliary tract anomaly and are particularly susceptible to injury at cholecystectomy because of their critical location. The authors report radiologic diagnosis and therapy in five cases of inadvertent ligation of this duct at cholecystectomy. The diagnosis was unsuspected prior to the radiologic studies in each patient. Four patients experienced recurrent cholangitis; one patient had chronic pain as the only symptom. Prior to diagnosis, the duration of symptoms ranged from 2 weeks to 126 months. Findings at ultrasound, computed tomography, and percutaneous transhepatic cholangiography with differential biliary pressures helped establish the diagnosis in each patient. Findings at endoscopic retrograde cholangiopancreatography were nondiagnostic in four patients. Percutaneous biliary drainage provided palliation of symptoms, improved each patient's condition prior to reconstructive surgery, and provided an intraoperative landmark for the surgeon. Two patients had associated bilomas, one of which was infected and was drained percutaneously. All patients survived and recovered without further complications.