Management of Calculi in the Common Hepatic Duct and Accessory Right Hepatic Duct with T-Tube and C-Tube Drainage: A Case Report.

Abstract

Introduction: Biliary tract stones are a common clinical condition. The primary clinical symptoms include intermittent pain in the right upper quadrant and upper abdomen. During acute episodes, the pain may become persistent. A small number of patients may also present with jaundice.

Case presentation: An 80-year-old male was admitted to the hospital due to right upper quadrant pain persisting for over 12 h. Examination revealed that the patient had common bile duct stones with cholangitis, as well as gallbladder stones with cholecystitis. The patient's biliary anatomy showed the cystic duct opening into an accessory right hepatic duct, which formed a low confluence with the common hepatic duct to become the common bile duct. Surgical intervention was therefore performed. We managed the stones in this anatomically complex biliary configuration by placing a C-tube through the cystic duct, performing primary closure of the accessory right hepatic duct, and placing a T-tube in the common hepatic duct.

Conclusion: The patient recovered well postoperatively. By placing the C-tube and performing primary closure of the accessory right hepatic duct, we reduced the incidence of bile leakage and concurrently lowered the risk of soft tissue infection at the incision site and intra-abdominal infection. Furthermore, the placement of a C-tube offers an alternative approach for managing accidental bile duct injury during biliary surgery.