PMC6104581_01
Preoperative MRI image. The cystic duct is shown (arrow). MRI reveals no anomalous bile duct.
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Magnetic resonance imaging (MRI) revealed no aberrant bile duct (Fig. 1).
Findings from Calot's triangle during laparoscopic cholecystectomy. (a) A linear structure (arrowhead) is seen posterior to the cystic artery (arrow) under normal light. (b) The structure thought to represent an aberrant bile duct (arrowhead) shows fluorescence under near-infrared light. (c)The cystic artery (arrow) shows fluorescence under near-infrared light after intravenous injection of 2 ml of ICG during the operation. Posterior to the cystic artery, an aberrant bile duct is evident (arrowhead).
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During dissection, we recognized a linear structure posterior to the cystic artery (Fig. 2a). This structure showed fluorescence under near-infrared light, and was considered likely to represent an aberrant bile duct (Fig. 2b). To confirm the anatomy, we reinjected 2 ml of ICG intravenously during LC and confirmed that the cystic artery showing fluorescence under near-infrared light was located anterior to the identified structure (Fig. 2c).
Findings of the aberrant bile duct after laparoscopic cholecystectomy. (a) The aberrant bile duct (arrowhead) branching from the right side of the common hepatic duct appears well preserved under normal light. (b) The aberrant bile duct (arrowhead) shows fluorescence under near-infrared light.
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We thus diagnosed the structure as an aberrant bile duct, and LC was completed without injuring this duct (Fig. 3a, b).