PMC6664166_01
Magnetic resonance image (a) and magnetic resonance cholangiopancreatography (b) showed an aberrant bile duct (arrows) in the gallbladder fossa. Gallbladder was indicated by arrow heads.
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In preoperative work-up, sign of invasion was not apparent, and a string-like structure with high intensity traversing in the peri-hepatic connective tissue of the gallbladder fossa was shown by MRCP suggesting an aberrant bile duct (Fig. 1).
Intraoperative fluorescence cholangiography demonstrated the aberrant bile duct (arrows).
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At the time of laparotomy (about one hour after injection of ICG), although the abnormal structure was not identified macroscopically, IFC demonstrated a lumen-like structure with the similar intensity as gallbladder and extrahepatic bile duct (Fig. 2), and the structure was deemed to contain bile juice.
Intraoperative identification (a) and ligation (b) of the aberrant bile duct (arrows) during dissection of gallbladder fossa.
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Using IFC as a guide, gallbladder fossa was dissected and the duct was identified, ligated and divided (Fig. 3).
Macroscopic examination of resected gallbladder revealed a papillary polypoid tumor (arrows).
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Macroscopically, a papillary polypoid tumor 11 mm in size was noted in the body of the resected gallbladder (Fig. 4).