Low insertion of a cystic duct into the common bile duct as a cause for a malpositioned biliary stent: demonstration with multidetector computed tomography

George RA, Debnath J, Singh K, Satija L, Bhargava S, Vaidya A
Correspondence: Lt Col (Dr) Jyotindu Debnath, jyotindu_debnath@rediffmail.com

ABSTRACT
Anatomical variations of the extrahepatic biliary system are common. Adequate knowledge of such variations and an appropriate roadmap before any surgical, endoscopic or percutaneous procedure/intervention help in preventing associated complications. Multiple imaging modalities can depict the anatomy of the extrahepatic biliary tree. High resolution magnetic resonance imaging and magnetic resonance cholangiopancreatography are increasingly used to delineate the hepatobiliary system. Multidetector computed tomography allows for high-speed volume scanning with an excellent spatial and temporal resolution. It also allows for multiplanar reconstructions in virtually any plane, with isotropic resolution. We describe an unusual complication of biliary stenting in a 62-year-old man with low insertion of a cystic duct, resulting in the inadvertent placement of the common bile duct stent into the cystic duct. This was demonstrated well by multidetector computed tomography and confirmed thereafter, during surgery.

Keywords: biliary anatomical variants, cystic duct lesions, low insertion of cystic duct, malpositioned biliary stent, multidetector computed tomography
Singapore Med J 2009; 50(7): e243-e246