A case of a right accessory hepatic duct diagnosed during a Whipple procedure

INTRODUCTION: Although anatomic variations of the bile tract are relatively common and can be present in about 28% of patients, existence of an accessory right hepatic duct that confluence on the common bile duct is quite rare. PRESENTATION OF CASE: We present a rare case of a caucasian 78-years-old patient, with accessory right hepatic duct which was diagnosed intraoperatively. The patient was submitted to Whipple procedure due to a mass in the head of pancreas. Intraoperatively, an accessory right hepatic duct that merged with the common bile duct was found, and a double bilio-intestinal anastomosis was performed. DISCUSSION: Definition of accessory hepatic duct, requires the existence of a main right hepatic duct, otherwise the definition of “accessory” is inconclusive. In our case the accessory right hepatic duct drained the posterior segments of the right hepatic lobe. CONCLUSION: A detailed mapping of the biliary tree is essential in patients that will undergo major interventions of the hepatobiliary system. Common and rare variations of the biliary tree should be known prior to any intervention to avoid intraoperative difficulties or complications.