title: Common bile duct injury following laparoscopic cholecystectomy in the setting of sinistroposition of the galladder and biliary confluence: a case report.
abstract: BACKGROUND
  A bile duct injury occurred to a 64-year-old female with highly aberrant bile ducts due to sinistroposition. Methods of potential injury avoidance are discussed.
  
  
  METHODS
  A patient underwent elective laparoscopic cholecystectomy for symptomatic cholelithiasis. A left-sided gallbladder was diagnosed intraoperatively. Three days later, the patient presented with jaundice and rising liver function tests. The patient was referred to our institution for suspected bile duct injury. Endoscopic retrograde cholangiopancreatography showed complete occlusion of the common bile duct. A percutaneous transhepatic tube was placed in the bile ducts for decompression. During later operative exploration, a left-sided common hepatic duct was discovered. Review of preoperative imaging confirmed that the right hepatic duct crossed superior to the umbilical portion of the left portal vein and that segment 4 ducts drained into the right anterior sectional bile duct.
  
  
  CONCLUSIONS
  This case describes an extremely rare anomaly associated with an injury to the common bile duct during laparoscopic cholecystectomy. Knowledge of the complex and unusual alterations in biliary anatomy, which may accompany sinistroposition of the gallbladder, should aid in avoidance of such injuries in the future.
authors.affiliation: Section of HPB Surgery, Washington University in Saint Louis, Campus Box 8109, St. Louis, MO 63110, USA.
authors.forename: Tricia A
authors.initials: TA
authors.lastname: Moo-Young
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Picus
authors.forename: Sherry
authors.initials: S
authors.lastname: Teefey
authors.forename: Steven M
authors.initials: SM
authors.lastname: Strasberg
mesh_terms: D001652:Bile Ducts / Q000002:abnormalities*; D002758:Cholangiography; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D002769:Cholelithiasis / Q000601:surgery*; D003135:Common Bile Duct / Q000293:injuries*; D005260:Female; D005704:Gallbladder / Q000002:abnormalities*; D006801:Humans; D008875:Middle Aged