Anatomical abnormality of the bile ducts?

Anatomical abnormality of the bile ducts?
Vlad Iovănescu, Medical Clinic 1. UMF Craiova

A 68-year-old patient, cholecystectomized, with a post-operative biliary fistula (clear ball of 300-400 ml / day on the drain tube), with choledochal lithiasis diagnosed by cholangio-MRI, is sent for ERCP. Shortly after the transfer, he presents with intense abdominal pain and vomiting, with hydroaerial levels on the empty abdominal radiograph. The diagnosis of acute surgical abdomen is established and laparoscopic intervention is performed, finding bile fluid in the peritoneal cavity and the clips previously mounted on the partially skidded cystic duct, with bile evacuation from this level. The cystic abutment implanted in a tubular structure apparently parallel to CBP is identified; the cystic duct is reclipated and the peritoneal toilet is performed. ERCP performed at 48 hours shows 10 mm CBP, with multiple filling defects up to 5/7 mm, and extravasation of the contrast substance outside the lumen; the anterograde filling of a duct apparently parallel to the choledochus, which communicates with it, is also visualized. Lithiasis is extracted and two stents of 10 Fr / 10 cm are mounted on the choledochus.