THE ACCESSORY CYSTIC DUCT: THE IMPORTANCE OF ANATOMICAL VARIATIONS IN THE SURGICAL PRACTICE

• DOI: 10.22533/at.ed.1593392331053

• Palavras-chave: Accessory Cystic Duct; Anatomical Variations; Surgical Practice

• Keywords: Accessory Cystic Duct; Anatomical Variations; Surgical Practice

• Abstract:

  Introduction

  Anomalies in the cystic ducts are not frequently seen, but anatomical variations of the biliary tract are common and usually identified through imaging tests or during the intraoperative period. Despite their frequency, they are rarely identified before adulthood, and can cause jaundice and biliary colic with no apparent cause. Thus, the aim of this study is to emphasize the importance of anatomical knowledge of the biliary tract, its anatomical variations and alterations associated with pathological processes in order to obtain an accurate diagnosis and thus optimize the clinical or surgical approach.

  Case report

  N.C.D, female, 32 years old, was admitted to the health service complaining of abdominal pain, associated with nausea, vomiting and jaundice +/4, with a positive Murphy's sign. Ultrasound showed a distended gallbladder, with heterogeneous content, with suspended debris and thickened walls measuring 0.6 cm. The blood test did not demonstrate leukocytosis, while liver enzymes were altered. Due to the set of findings, the diagnosis of acute cholecystitis was confirmed, and the surgical approach was indicated. During the cholecystectomy, the presence of an accessory cystic duct was observed, which was sectioned and ligated with sutupak thread. During surgery, the biliary tract was studied through transcystic intraoperative cholangiography with a delaton probe. The images did not show evidence of calculi in the common bile duct and after the procedure, the patient was referred for recovery, being discharged a few days after surgery.

  Discussion

  Despite the importance of diversity in the anatomy of the biliary tract, few studies in the literature describe the formation of accessory cystic ducts. In this sense, it is emphasized that knowledge of anatomical variations is essential, with cholangioresonance being the ideal exam for studying the biliary tract, in order to avoid possible surgical complications, such as inadequate section of a bile duct. In context, despite this variation, the surgery was uneventful, with only the surprise finding of an accessory cystic duct.

  Conclusion

  The identification of anatomical variations of the biliary tract is important to avoid an incorrect diagnosis or surgical complications. With this case report, the complexity of the biliary tract and the relevance of the subject for the safe performance of surgical procedures are evident.