Images in surgery| Volume 142, ISSUE 3, P424-425, September 2007

The missing common bile duct (hepaticocystic duct)

  • Omar Shah
    Reprint requests: Omar Shah, Professor, SKIMS Surgical Gastroenterology Kral-sangri, Brein, Nishat, Srinagar, Srinagar, JK, India 0091-0194-2463774.
    Department of Surgical Gastroenterology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
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Published:February 16, 2007DOI:
      A 45-year-old female patient presented to us with cholangitis. There was leucocytosis with neutrophilia, raised serum bilirubin (4.4 mg/dl), raised alkaline phosphatase (630 IU/1), normal transaminase levels, and a normal coagulation profile. Ultrasonography (USG) revealed the presence of a shrunken gallbladder with stones in the neck, an abrupt change in the dilated common hepatic duct (CHD) to a normal caliber below the stone, and a dilated proximal biliary tree. Endoscopic retrograde cholangiopancreaticography (ERCP) revealed an impacted stone at the mouth of the cystic duct with a dilated ductal system above it. The preoperative diagnosis was Mirizzi’s syndrome.
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