title: Old is still gold.
abstract: Common bile duct injury is infrequent but a serious complication of cholecystectomy. Variable biliary anatomy has an increased risk of iatrogenic injury. Intraoperative cholangiogram can be performed to provide a clearer picture of biliary anatomy. We report a case of a 71-year-old lady who underwent cholecystectomy for symptomatic gallstones. Anatomy initially was misinterpreted at laparoscopy when common bile duct was identified as a cystic duct, and a hole in what appeared to be Hartmann's pouch was in fact in common hepatic duct. If continued laparoscopically, further misconception could have led to the complete excision of the biliary system. Instead, procedure was converted to an open and intraoperative cholangiogram performed, which confirmed a diagnosis of Mirizzi syndrome. Following the identification of structures, subtotal cholecystectomy was completed. The patient made an uneventful recovery. This case highlights the limitations of laparoscopy and the importance of an intraoperative cholangiogram. Despite advances in surgical techniques, we continue to advocate a low threshold for its use during cholecystectomy as a useful tool in evaluating and minimising the extent of biliary injury.
authors: Postgraduate Department, Lancashire Teaching Hospital Foundation Trust, Chorley, UK. ketakeens@doctors.org.uk
authors: Keta L
authors: KL
authors: Keens
authors: Kishore G
authors: KG
authors: Pursnani
authors: Jeremy B
authors: JB
authors: Ward
authors: Ravindra S
authors: RS
authors: Date
mesh_terms: D000368:Aged; D002758:Cholangiography; D017081:Cholecystectomy, Laparoscopic; D003135:Common Bile Duct / Q000601:surgery; D003549:Cystic Duct / Q000601:surgery; D005260:Female; D042882:Gallstones / Q000601:surgery; D006500:Hepatic Duct, Common / Q000601:surgery; D006801:Humans; D007432:Intraoperative Period; D057792:Mirizzi Syndrome / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery
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