title: Liver segment IV hypoplasia as a risk factor for bile duct injury.
abstract: BACKGROUND
  Bile duct injury remains constant in the era of laparoscopic cholecystectomy and misidentification of structures remains one of the most common causes of such injuries. Abnormalities in liver segment IV, which is fully visible during laparoscopic cholecystectomy, may contribute to misidentification as proposed herein.
  
  
  METHODS
  We describe the case of a 36-year-old female who had a bile duct injury during a laparoscopic cholecystectomy where the surgeon noticed an unusually small distance between the gallbladder and the round ligament.
  
  
  RESULTS
  We define hypoplasia of liver segment IV as well as describe the variation of the biliary anatomy in the case. We also intend to fit it in a broader spectrum of developmental anomalies that have both hyopoplasia of some portion of the liver and variations in gallbladder and bile duct anatomy that may contribute to bile duct injury.
  
  
  CONCLUSIONS
  To our knowledge, hypoplasia of liver segment IV has not been suggested in the literature as a risk factor for bile duct injury except in the extreme case of a left-sided gallbladder. Surgeons should be vigilant during laparoscopic cholecystectomy when they become aware of an unusually small distance between the gallbladder bed and the round ligament prior to beginning their dissection, variations in the common bile duct and cystic duct should be expected.
authors.affiliation: Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Tlalpan, 14000, México City, México. mamercado@quetzal.innsz.mx
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Mercado
authors.forename: Bernardo
authors.initials: B
authors.lastname: Franssen
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Arriola
authors.forename: Artemio
authors.initials: A
authors.lastname: Garcia-Badiola
authors.forename: Rigoberto
authors.initials: R
authors.lastname: Arámburo
authors.forename: Alejandro
authors.initials: A
authors.lastname: Elnecavé
authors.forename: Rubén
authors.initials: R
authors.lastname: Cortés-González
mesh_terms: D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D003135:Common Bile Duct / Q000293:injuries*; D005260:Female; D042882:Gallstones / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D008099:Liver / Q000002:abnormalities*