Double cystic duct.

Abstract

demonstrated a 1.7-cm stone in the neck of the gallbladder, and an elective laparoscopic cholecystectomy was scheduled. Physical examination and laboratory tests, including those for liver function, gave normal results. At laparoscopic exploration, the cystic duct was identified and a transcystic duct cholangiogram confirmed filling of the common bile duct with retrograde filling of the left and right hepatic systems (Fig. 1, left). The cystic duct was clipped and divided. Further dissection of the infundibulum revealed a separate, additional tubular structure emanating from the neck of the gallbladder. Repeat cholangiography through this structure (Fig. 1, right) showed immediate filling of the right hepatic system with antegrade filling of the left hepatic and common bile ducts. The accessory cystic duct was ligated and transected, and the remainder of the laparoscopic cholecystectomy was performed routinely. The patient was discharged on the day of surgery and had an uncomplicated postoperative course. Gross pathological examination confirmed 2 separate cystic ducts exiting the gallbladder (Fig. 2). Discussion Variation in cystic duct anatomy is quite common. The standard relationship of