PMC3524691_01
(A) A calculus deviated from the hepatoduodenal ligament was recognized in the right upper peritoneal space (arrow). The wall of the gallbladder (GB) shows evidence of thickening. No GB stones are visible. (B) A small amount of ascites has accumulated in Morison' pouch. Several calculi similar to the deviated calculus are visible in the common bile duct (arrow).
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f1-medscimonit-17-1-cs8
Of note, a calculus deviated from the biliary duct and an abscess located ventral to the hepatoduodenal ligament were observed (Figure 1A). Calculi with a density approximately equal to that of the deviated calculus were also detected in the common bile duct (Figure 1B).
(A) The arrow indicates the hole in the anterior wall of the bile duct. The hepatoduodenal ligament became friable because of an infection. (B) The calculi were grasped with forceps and removed carefully. (C) A T tube was inserted from the perforated site, and a cholangiography was performed using a low pressure.
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f2-medscimonit-17-1-cs8
The bile source was a perforated hole with a diameter of 10 mm in the anterior wall of the bile duct (Figure 2A). After the extirpation of the gallbladder, several common duct stones were removed (Figure 2B). A T tube was placed into the hole of the perforation and secured using sutures (Figure 2C).
(A) Intraoperative cholangiography shows the perforation in the left hepatic duct; no calculi remain in the bile duct. No other perforations or stenosis in Calot' triangle were observed. (B) Magnetic resonance cholangiopancreatography examination performed 1 year after surgery shows a healthy bile duct with no signs of stenosis or dilatation.
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f3-medscimonit-17-1-cs8
No calculi were remaining in the bile duct, and other perforated site observed using intraoperative cholangiography (Figure 3A). At a 1-year follow-up examination (using magnetic resonance cholangiopancreatography), the patient was in good health and her liver function tests were normal (Figure 3B).