PMC9955506_01
Cholangiogram showing variant biliary anatomy in Case 1 with a guidewire in the right posterior duct which directly joins the common hepatic duct (arrow).. RHD: right hepatic duct; LHD: left hepatic duct; CHD: common hepatic duct; CBD: common bile duct
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FIG1
During occlusion cholangiogram, variant biliary anatomy was noted with an isolated right posterior duct draining from segment 6 draining directly into the common hepatic duct, separate from the confluence of the right and left hepatic ducts (Figure 1).
PMC9955506_02
Occlusion cholangiogram without evidence of bile leak in Case 2. Black arrow points to cholecystectomy clips and red arrow points to cystic duct remnant.
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FIG2
The cholangiogram was normal without bile leak (intra-procedural radiology consultation concurred with findings) and some sludge was swept from the duct (Figure 2).
Biliary fistula between hepatic segment 6/7 and duodenum in Case 2 (arrow).. S6: hepatic segment 6; S7: hepatic segment 7; D1: first portion of duodenum; D2: second portion of duodenum
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FIG3
This was likely a consequence of inadvertent bile duct injury during surgery, related to variant biliary anatomy, specifically an isolated right posterior duct (Figure 3).