title: Right hepatic duct emptying into the cystic duct: report of a case.
abstract: BACKGROUND
  Anomalous insertion of the right hepatic duct into the cystic duct is a rare anatomic variation. At this writing, only nine cases have been reported in the literature. In the patients presenting with this anomaly, the surgeon may accidentally transect the right hepatic duct during cholecystectomy.
  
  
  METHODS
  We encountered a case of anomalous insertion of the right hepatic duct into the cystic duct, which was clearly demonstrated in the intraoperative cholangiography during laparoscopic cholecystectomy.
  
  
  RESULTS
  As the half-cut point of the cystic duct happened to be on the gallbladder side of the cystic duct, cholecystectomy was accomplished laparoscopically.
  
  
  CONCLUSIONS
  In anomalous insertion of the right hepatic duct into the cystic duct, hepatic duct transection could happen. Preoperative precise evaluation of the biliary duct, awareness of potential biliary variations, and identification of all anatomic structures before ligation and division were essential to prevent bile duct injury.
authors.affiliation: Department of Digestive Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-Ku Tokyo 105-8470 Japan. masajih-ind@umin.ac.jp
authors.forename: M
authors.initials: M
authors.lastname: Hashimoto
authors.forename: M
authors.initials: M
authors.lastname: Hashimoto
authors.forename: T
authors.initials: T
authors.lastname: Ishikawa
authors.forename: T
authors.initials: T
authors.lastname: Iizuka
authors.forename: M
authors.initials: M
authors.lastname: Matsuda
authors.forename: G
authors.initials: G
authors.lastname: Watanabe
mesh_terms: D000368:Aged; D001652:Bile Ducts / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D002769:Cholelithiasis / Q000175:diagnosis / Q000601:surgery; D005260:Female; D005704:Gallbladder / Q000000981:diagnostic imaging / Q000601:surgery; D006500:Hepatic Duct, Common / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000601:surgery; D014463:Ultrasonography