Subvesical bile duct and the importance of the critical view of safety: Report of a case

INTRODUCTION: This is a case report in which a subvesical duct was identified intra-operatively during laparoscopic cholecystectomy. PRESENTATION OF CASE: A 49-year-old man underwent elective laparoscopic cholecystectomy for symptomatic cholelithiasis. During the procedure, the cystic duct and cystic artery were dissected. After ligation and division of these structures, a subvesical bile duct draining directly into the gallbladder was noted. In the present case, the subvesical duct was ligated and divided. The patient had an uneventful recovery. DISCUSSION: Subvesical bile ducts, also known as ducts of Luschka, represent anatomic variations of the biliary tree in which one or more bile ducts traverse in close contact with the gallbladder fossa. Inadvertent and undetected injury of these ducts are a frequent cause of cholecystectomy-associated bile leaks. CONCLUSION: Application of the critical view of safety principle may assist in intra-operative detection of aberrant biliary anatomy, thus preventing iatrogenic injury.