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JAMA Surgery Clinical Challenge
October 2015

An Abnormal Intraoperative Cholangiogram

Author Affiliations
  • 1Northwick Park Hospital, North West London Hospitals NHS Trust, London, England
  • 2Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London, England
JAMA Surg. 2015;150(10):1009-1010. doi:10.1001/jamasurg.2015.0957

A 57-year-old woman with a medical history of recurrent biliary colic was admitted with symptoms consistent with mild gallstone pancreatitis. Routine laboratory test results showed total bilirubin of 4.74 mg/dL (to convert to millimoles per liter, multiply by 17.104) and amylase of 1.041 U/L (to convert to microkatals per liter, multiply by 0.0167). An abdominal ultrasonography scan demonstrated gallstones and a mildly dilated common bile duct (CBD). Magnetic resonance imaging of the abdomen confirmed these results and revealed cholelithiasis. The patient consequently underwent urgent laparoscopic cholecystectomy with intraoperative cholangiography (Figure, A). Intraoperative cholangiography revealed an unusual anatomical variant and subsequent transcystic choledochoscopy was performed, which demonstrated a double lumen at the distal CBD (Figure, B). Multiple gallstones were found within a dilated region of cystic duct.

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