Two Patients with Very Rare Biliary Anomalies: Difficult to Interpret on Imaging, Needing Traditional Techniques of Biliary Drainage

Open common bile duct (CBD) exploration has a few indications today, especially due to magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrieval being in vogue.A 58-year-old woman with large (2 cm), multiple CBD stones and a low confluence on MRCP underwent laparotomy.The tortuous cystic duct (CD) opening was common posteriorly with the right posterior duct (RP); very low (just above the ampulla), and partially stenosed with multiple calculi.It necessitated a supraduodenal choledochotomy, gentle probing, incising of the RP opening, and suturing transversely ("transchodedochal sphinteroplasty").A common opening with this anomaly has been reported very rarely (nine cases).A unique operative approach of "transcholedochal" or "supraduodenal" sphincteroplasty instead of transduodenal was adopted.The second patient was a young woman with suspected post-inflammatory benign lower CBD stricture on MRCP; the final diagnosis was an interposition of the gallbladder or hepatcocystic duct, a very rare entity.