PMC3662734_01
MRCP. Arrow points to the remnant gallbladder with filling defects and normal extrahepatic biliary tree.
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F1
As part of her workup, magnetic resonance cholangiopancreatography (MRCP) was performed (Figure 1), which demonstrated a large gallbladder remnant with gallstones and normal caliber extrahepatic biliary tree.
Laparoscopic view of remnant gallbladder during adhesiolysis. Black arrows denote the border of the gallbladder.
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F2
Inferior margin of the liver was carefully elevated, and a large dilated gallbladder remnant was identified (Figure 2).
Critical view of safety. The cystic duct (white arrow) and the cystic artery (black arrow) seen to be the only 2 structures entering into the remnant gallbladder with normal liver demonstrated behind them.
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F3
The hepatocystic plate was also partially mobilized, and a critical view of safety with normal hepatic parenchyma behind this structure was obtained (Figure 3).
Laparoscopic transcystic common bile duct exploration with a balloon extraction catheter in the cystic duct. The white arrow depicts the cannula in the cystic duct; the black arrow shows the remnant gallbladder.
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F4
After dilation of the cystic duct, the access cannula was placed into the duct and a guidewire was inserted through this into the duodenum (Figure 4).
A, Gross specimen. The white solid arrow marks clips from the previous operation; the black thin arrow marks the clip on the cystic duct. B, The gross specimen, opened, demonstrating retained stones.
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F5
Examination of the gallbladder was performed immediately after its removal (Figure 5a and 5b).