Cholangiography: Rare Anatomical Variation of the Bile Duct

We present a cholangiographic anatomical variation of the main bile duct discovered during laparoscopic cholecystectomy (Fig. 1). It is classified as type A5, according to the Huang classification: right posterolateral duct opens into the cystic duct (frequency of 1%). This variation has a high risk of bile duct injury. Cholangiography and achieving Strasberg's critical view of safety (Fig. 2) are fundamental elements for performing a safe cholecystectomy while minimizing the risk of iatrogenic injury to the main bile duct. Although cholangiography does not prevent these injuries, it can diagnose them intraoperatively for resolution during surgery.

Fig. 1

Fig. 2