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CC BY 4.0 · Endoscopy 2023; 55(S 01): E806-E807
DOI: 10.1055/a-2098-1439
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Management of rare biliary duct variants using a nasobiliary drainage tube and wire-guided navigation during laparoscopic cholecystectomy: a case report

Authors

  • Cheng Zhang 

    Department of hepatobiliary surgery, Chengdu Second People’s Hospital, Chengdu, China

  • Yun-sheng Suo

    Department of hepatobiliary surgery, Chengdu Second People’s Hospital, Chengdu, China

  • Sheng-long Zhang

    Department of hepatobiliary surgery, Chengdu Second People’s Hospital, Chengdu, China

  • Ke Sun

    Department of hepatobiliary surgery, Chengdu Second People’s Hospital, Chengdu, China

  • Yang He

    Department of hepatobiliary surgery, Chengdu Second People’s Hospital, Chengdu, China

  • Guang-kuo Li

    Department of hepatobiliary surgery, Chengdu Second People’s Hospital, Chengdu, China
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Biliary anatomical variation is an important risk factor for bile duct injury during laparoscopic cholecystectomy [1]. In the present case, we used a nasobiliary drainage tube and wire-guided navigation to identify a rare biliary variant and provide intraoperative guidance to reduce the risk of bile duct injury during laparoscopic cholecystectomy ([Video 1]).

Video 1 Use of a nasobiliary drainage tube and wire-guided navigation to identify a rare biliary variant and provide intraoperative guidance to reduce the risk of bile duct injury during laparoscopic cholecystectomy.

A 29-year-old woman was admitted with a 3-day history of upper abdominal pain and jaundice. Magnetic resonance cholangiopancreatography revealed that the cystic duct inserted into the right posterior sectoral duct (RPSD) and a suspected stone was located at the lower end of the common bile duct ([Fig. 1]). Endoscopic retrograde cholangiopancreatography confirmed the presence of an abnormal junction between the cystic duct and RPSD ([Fig. 2 a]), classified as type 4A according to the right hepatic duct variant classification by Huang et al. [2]. Attempts to selectively cannulate the RPSD using a sphincterotome and guidewire were unsuccessful. However, we successfully cannulated the RPSD using a nasobiliary drainage tube (nasal biliary drainage catheter, ENBD-7-LIGUORY-C; Cook, Limerick, Ireland) and wire-guided navigation, confirming the aberrant junction of the cystic duct with the RPSD ([Fig. 2 b]). During surgery, the surgeon injected indocyanine green through the nasobiliary catheter to identify the RPSD and avoid its injury ([Fig. 3]). Postoperative nasobiliary tube cholangiography revealed unobstructed flow in the RPSD ([Fig. 4]).

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Fig. 1 Magnetic resonance cholangiopancreatography (MRCP) showing that the cystic duct inserted into the right posterior sectoral duct and that a suspected stone was located at the lower end of the common bile duct.
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Fig. 2 Endoscopic retrograde cholangiopancreatography showing: a a rare biliary anatomical variant; and b successful cannulation of the right posterior sectoral duct using a nasobiliary drainage tube and wire-guided navigation.
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Fig. 3 Injection of indocyanine green through the nasobiliary drainage tube to identify the right posterior sectoral duct and avoid injury to it.
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Fig. 4 Postoperative nasobiliary tube cholangiography showing unobstructed flow in the right posterior sectoral duct.

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Competing interests

The authors declare that they have no conflict of interest.


Corresponding author

Guang-kuo Li, MD, PhD
Department of Hepatobiliary Surgery
Chengdu Second People’s Hospital
No. 10 Qingyun Nan Street
Jinjiang District
Chengdu
Sichuan 610021
China   
Fax: +86-28-67830666   

Publication History

Article published online:
15 June 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
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Zoom
Fig. 1 Magnetic resonance cholangiopancreatography (MRCP) showing that the cystic duct inserted into the right posterior sectoral duct and that a suspected stone was located at the lower end of the common bile duct.
Zoom
Fig. 2 Endoscopic retrograde cholangiopancreatography showing: a a rare biliary anatomical variant; and b successful cannulation of the right posterior sectoral duct using a nasobiliary drainage tube and wire-guided navigation.
Zoom
Fig. 3 Injection of indocyanine green through the nasobiliary drainage tube to identify the right posterior sectoral duct and avoid injury to it.
Zoom
Fig. 4 Postoperative nasobiliary tube cholangiography showing unobstructed flow in the right posterior sectoral duct.