超低位汇合胆囊管变异伴胰腺段胆囊管结石误诊为胆总管下段结石一例OA

Summary This paper reported a 17-year-old male patient who was admitted to Beilun District People's Hospital of Ningbo due to right upper abdominal pain.Preoperative magnetic resonance cholangiopancreatography(MRCP)diagnosed as lower common bile duct(CBD)stones complicated by cholangitis,gallbladder stones with cholecystitis.The patient then received laparoscopic common bile duct exploration(LCBDE)combined with laparoscopic cholecystectomy(LC).Intraoperative choledochoscopy revealed no stones in the CBD,only obvious external compressive changes on the left wall of the lower CBD.Combined with the relief of preoperative symptoms and verification of imaging and anatomical structures,it was considered that the cystic duct had an ultra-low confluence into the pancreatic segment of the CBD with impacted stones.Due to significant local inflammation,a T-tube was placed followed by conventional treatment,and the patient was discharged smoothly.Eight weeks after surgery,the T-tube slipped.Re-examination of MRCP confirmed that the residual cystic duct ran parallel to the lower CBD and converged into the pancreas,with residual stones in the pancreatic segment of the cystic duct.A review of the preoperative MRCP showed that overlapping of the cystic duct and CBD,combined with inflammatory compression,resulted in poor imaging,leading to misdiagnosis of the cystic duct and its internal stones as the lower CBD and CBD stones.More than 3 months after surgery,the patient remained asymptomatic,and declined further surgical intervention,so was under close follow-up.Based on this case,this paper discusses the characteristics of cystic duct anatomical variations,as well as the advantages and limitations of MRCP in biliary tract assessment.It points out that MRCP is prone to misdiagnosing ultra-low confluent cystic duct variations due to structural overlap and dependence on biliary filling.It emphasizes the need to integrate multiple imaging data and the experience of senior physicians preoperatively,and dynamically verify anatomical structures intraoperatively to improve the diagnostic evidence chain.