Near-Miss Hepatic Duct Injury Resulting From Misidentification of Calot’s Triangle During Laparoscopic Cholecystectomy

Yoichi Matsui, MD, Satoshi Hirooka, MD, So Yamaki, MD, Sohei Satoi, MD, FACS

Department of Surgery, Kansai Medical University (all authors).


Introduction: Bile duct injury is a serious and life-threatening problem. This well-known, albeit rare, problem is an important complication of laparoscopic cholecystectomy.

Case Description: A 74-year-old woman was referred to our surgical department for elective cholecystectomy due to gallstone disease. We proceeded with elective laparoscopic cholecystectomy as planned. Dissection near Calot’s triangle was initiated to obtain the critical view of safety. The dissection gradually revealed a thin, bile duct–like structure adhered to the gallbladder surface. The bile duct–like structure was finally revealed to be the common hepatic duct, which had been pulled from its normal position and was stuck to the gallbladder body. Until this point in the operation, the common hepatic duct had been mistaken for the cystic duct and was almost divided. The true Calot’s triangle was then recognized and dissected. The true cystic duct and cystic artery were then identified. The common hepatic duct was firmly adhered to the gallbladder body and was difficult to release from the gallbladder wall. Therefore, subtotal cholecystectomy was completed.

Conclusions: Careful intraoperative observation of Calot’s triangle is important to prevent bile duct injury. If surgeons find it difficult to identify the location of this triangle, they should perform subtotal cholecystectomy to prevent intraoperative complications.

Key Words: Bile duct injury, Calot’s triangle, critical view of safety, laparoscopic cholecystectomy, subtotal cholecystectomy.

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