Table of Contents    
Case Report
 
Challenges in management of right aberrant hepatic duct injury
Jayashri S. Pandya1, Sudatta B. Waghmare2, Makrand M. Thakre3, Nilesh H. Doctor4
1M.S. General Surgery, Professor, General Surgery Department and Incharge Emergency Trauma services, T.N.M.C & B.Y.L. Nair Hospital, Mumbai, Maharashtra, India.
2M.S. General Surgery, Assistant Professor, General Surgery Department, T.N.M.C & B.Y.L. Nair Hospital, Mumbai, Maharashtra, India.
3PG Resident in General Surgery, Third year resident, General Surgery dept., T.N.M.C & B.Y.L. Nair Hospital, Mumbai, Maharashtra, India.
4M.S. General Surgery, Consultant Hepatobiliary Surgeon, Jaslok Hospital, Mumbai, Maharashtra, India.

Article ID: 100046IJHPDJP2016
doi:10.5348/ijhpd-2016-46-CR-2

Address correspondence to:
Dr. Jayashri S Pandya
B/101 Gokul Monarch
Thakur complex, Kandivali East
Mumbai
India-400101

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How to cite this article:
Pandya JS, Waghmare SB, Thakre MM, Doctor NH. Challenges in management of right aberrant hepatic duct injury. Int J Hepatobiliary Pancreat Dis 2016;6:6–9.


Abstract
Introduction: Bile duct injury (BDI) is a known complication following laparoscopic cholecystectomy. Variation in biliary tree anatomy occurs in about 25% patients with aberrant right hepatic duct being the most common [1]. Low insertion of the right hepatic duct puts it at risk of damage during dissection of the Calot's triangle. The resulting isolated right posterior BDI poses a challenge for both diagnosis and management.
Case Report: We present a case of a persistent bile leak after laparoscopic cholecystectomy. Diagnosis of an aberrant right hepatic sectoral duct injury was confirmed by MRCP, and managed by Roux-en-Y hepaticojejunostomy.
Conclusion: Right posterior hepatic duct opening located close to cystic duct is a dangerous scenario. Due to its location, it has high potential to get injured. The leak may then be erroneously attributed to injury to minor biliary radicle in gallbladder fossa and delay the diagnosis. Hence, there should be high index of suspicion to diagnose such injuries, as interpretation of ERCP images may be erroneous.

Keywords: Bile duct injury, Cholecystectomy, Hepaticojejunostomy, Sectoral bile duct


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Author Contributions
Jayashri S. Pandya – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Sudatta B. Waghmare – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Makrand M. Thakre – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Nilesh H. Doctor – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
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Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Jayashri S. Pandya et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.