Laparoscopic management of a rare intrahepatic bile duct variation in a patient with cholelithiasis: a case report and review of the literature

Anatomical variations of the biliary system constitute one of the principal risk factors for bile duct injury (BDI) during laparoscopic cholecystectomy (LC). Preoperative imaging modalities, such as abdominal ultrasonography and magnetic resonance cholangiopancreatography (MRCP), play a pivotal role in identifying potential biliary anatomical variations. In addition, meticulous adherence to standardized surgical techniques during LC serves as a critical safeguard against BDI. Therefore, heightened awareness and comprehensive understanding of biliary anatomical variations are essential for preventing intraoperative injury and mitigating the risk of severe, potentially irreversible postoperative complications. This report presents the case of a 37-year-old female patient admitted with symptomatic cholelithiasis accompanied by cholecystitis. Preoperative MRCP revealed an anatomical variation of the intrahepatic bile ducts. Following multidisciplinary team (MDT) evaluation, a detailed surgical plan was established. LC was subsequently performed, during which the biliary variation was carefully identified and preserved. The postoperative course was uneventful, and the patient was discharged in good condition. This case illustrates the value of preoperative MRCP in selected patients for identifying anatomical biliary variations, as well as the importance of MDT discussion and the development of a detailed surgical plan. During the procedure, the surgeon employed precise and adaptable operative techniques to successfully preserve the variant bile duct. Analysis of this case highlights that ongoing enhancement of surgeons’ understanding of biliary anatomy—particularly anatomical variations and their surgical implications—is essential. A solid knowledge of biliary anatomy provides a crucial theoretical foundation for preventing intraoperative BDI.