Three-dimensional imaging identified the accessory bile duct in a patient with cholangiocarcinoma

Abstract

The development of diagnostic imaging technology, such as multidetector computed tomography (MDCT) and magnetic resonance cholangiopancreatography (MRCP), has made it possible to obtain detailed images of the bile duct. Recent reports have indicated that a 3-dimensional (3D) reconstructed imaging system would be useful for understanding the liver anatomy before surgery. We have investigated a novel method that fuses MDCT and MRCP images. This novel system easily made it possible to detect the anatomical relationship between the vessels and bile duct in the portal hepatis. In this report, we describe a very rare case of extrahepatic cholangiocarcinoma associated with an accessory bile duct from the caudate lobe connecting with the intrapancreatic bile duct. We were unable to preoperatively detect this accessory bile duct using MDCT and MRCP. However, prior to the second operation, we were able to clearly visualise the injured accessory bile duct using our novel 3D imaging modality. In this report, we suggest that this imaging technique can be considered a novel and useful modality for understanding the anatomy of the portal hepatis, including the hilar bile duct.

Keywords: 3-dimensional imaging, Hepatobiliary and pancreatic surgery, Accessory bile duct, Caudate lobe bile duct, Cholangiocarcinoma

Core tip: We present a case study in which 3-dimensional (3D) images were reconstructed to detect a case of extrahepatic cholangiocarcinoma associated with an accessory bile duct from the caudate lobe connecting with the intrapancreatic bile duct. We could not detect this condition preoperatively using standard imaging techniques; however, the 3D reconstruction enabled us to visualise the bile duct and treat the patient successfully.