Ali Alenezi,Athary Saleem,Hamad Alajmi,Dalal Al Husainan,Odai Al Shadifat,Ahmed Bader,
Intraoperatively Diagnosed Double Cystic Duct During Laparoscopic Cholecystectomy: A Case Report of a Surgical Dilemma for the Operating Surgeons
American Journal of Surgical Case Reports
2024
2674-5046
http://dx.doi.org/10.31487/j.AJSCR.2024.01.04
https://www.sciencerepository.org/intraoperatively-diagnosed-double-cystic_AJSCR-2024-1-104 
Abstract: Introduction and Importance: A double cystic duct with a single gallbladder is one of the extremely uncommon variations of the cystic duct and only a few cases were reported in literature. 
Case Presentation: A 33-year-old female, with an unremarkable medical history, presented to the emergency department with a 2-day history of right upper quadrant abdominal (RUQ) pain. The abdominal pain was gradually increasing in intensity radiating to the back and was associated with anorexia and multiple episodes of vomiting. Abdominal examination revealed RUQ pain and tenderness. Abdominal ultrasonography was performed, showing a markedly distended gallbladder with evidence of a few calculi one of which was impacted at the neck. laparoscopic cholecystectomy was done within 2 days of admission during which another luminal structure was identified that suggested a double cystic duct. 
Clinical Discussion: Anomalies of the biliary tree are common with the classical anatomical picture presenting in only 33% of cholecystectomy cases. However, the presence of a double cystic duct is a rare variation, especially in the case of a single gallbladder. The identification of such anomaly can be achieved preoperatively using imaging modalities or it can be identified during the surgical procedure itself. such identification reduces the chances of postoperative comorbidities.
Conclusion: Pre-operative identification of biliary tract anomalies by different imaging modalities is limited. Hence the importance of cautiousness and achieving a proper critical view of safety intra-operatively to prevent possible complications intra- and post-operatively. Our case report emphasizes the diagnostic and surgical challenges of the double cystic duct.Keywords: Double cystic duct, common bile duct, cholecystectomy, case report