Congenital absence of the cystic duct: Case report of a rare anomaly and review of the literature

Congenital absence of the cystic duct: Case report of a rare anomaly and review of the literature

Congenital absence of the cystic duct is one of the rare types of anomalies associated with the extrahepatic biliary tract (EHBT). It is often an incidental finding intraoperatively leading to significant implications during the perioperative period. A 25-year-old lady was admitted for an elective l...

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Bibliographic Details
Published in:International journal of surgery case reports Vol. 96; p. 107353
Main Authors: Boushehry, Reem, Husain, Fatemah, Saleem, Athary, Alshamali, Mohammed, Alhammadi, Fahad, Mohammad, Khaleel
Format: Journal Article
Language:English
Published: Netherlands Elsevier Ltd 01-07-2022
Elsevier
Subjects:
Absent cystic duct
Biliary tract anomaly
Case Report
Cystic duct
Laparoscopic cholecystectomy
Case report
Biliary tract anomaly
CBD
Laparoscopic cholecystectomy
EHBT
MRCP
Cystic duct
ERCP
Absent cystic duct
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Summary:Congenital absence of the cystic duct is one of the rare types of anomalies associated with the extrahepatic biliary tract (EHBT). It is often an incidental finding intraoperatively leading to significant implications during the perioperative period. A 25-year-old lady was admitted for an elective laparoscopic cholecystectomy indicated for recurrent symptoms of right upper quadrant pain with evidence of cholelithiasis on ultrasound. During laparoscopy, the cystic duct could not be identified. After retrieval of the gallbladder, a blind ending orifice resembling an obliterated cystic duct was discovered. Absence of the cystic duct can result from a congenital or an acquired process. In both cases, they are difficult to diagnose pre-operatively even though magnetic resonance cholangiopancreatography (MRCP) has shown great potential in delineating the EHBT. It confers an increased risk of injury to the surrounding biliary tract during cholecystectomy. Therefore, the surgical approach depends on the surgeon's operative competency and knowledge related to EHBT anomalies. Definitive treatment for patients with symptomatic absent cystic duct is an open cholecystectomy, given its increased likelihood of iatrogenic morbidity. Nonetheless, it is important to highlight that laparoscopic cholecystectomy may be performed if the surgeon carries sufficient skills. •Congenital absence of the cystic duct is a rare anomaly of the bile duct.•Common presentation includes recurrent right upper quadrant pain with complications including jaundice and pancreatitis.•It is often diagnosed intraoperatively although imaging modalities such as the MRCP has shown great efficacy.•Open cholecystectomy is the ultimate treatment. Nonetheless, a laparoscopic approach may be attempted.
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ISSN:2210-2612
2210-2612
DOI:10.1016/j.ijscr.2022.107353