A MYSTERIOUS GALLBLADDER: OBLITERATED CYSTIC DUCT ENCOUNTERED DURING LAPAROSCOPIC CHOLECYSTECTOMY
*Dr. Abinesh M., Dr. Nithila C., Dr. Sabu Jeyasekharan, Dr. Daniel Devaprasath Jeyasekharan and Dr. Sakthivel A.
Background: Congenital absence or obliteration of the cystic duct is a rare biliary anomaly that may be discovered incidentally during cholecystectomy. Such anomalies increase the risk of bile duct injury, making early recognition and careful operative strategy essential. Case Presentation: A 70-year-old woman with a history of hypertension and hypothyroidism presented with intermittent colicky right upper abdominal pain and bloating for past one month. She had no fever, vomiting, jaundice, weight loss or history of prior upper abdominal surgery. Intraoperatively the cystic duct was found to be obliterated both proximally and distally. A single cystic artery entered the gallbladder at the critical angle of safety. The gallbladder was distended and contained multiple pigmented calculi, the largest measuring approximately 1 cm. A safe laparoscopic approach with careful identification of anatomy and limited dissection was successfully performed. The patient had an uneventful postoperative recovery. Conclusion: Absent or obliterated cystic duct, though rare, should be suspected when the anatomy is unclear intraoperatively. Pre- operative imaging, such as MRCP and intraoperative adjuncts, including cholangiography or indocyanine green fluorescence imaging, can aid in diagnosis and reduce the risk of iatrogenic bile duct injury. Surgeons should adhere to the principles of the critical view of safety and be prepared to modify the operative plan, including conversion to open surgery or biliary reconstruction if necessary.
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