Surgery for communicating accessory bile duct: Two case reports and a review of the literature

A communicating accessory bile duct (CABD) is a very rare and unique anomaly that makes a circuit of the biliary tree. We report 2 cases of CABD. A 58-year-old woman was found to have cancer of the head of the pancreas. Preoperative endoscopic retrograde cholangiopancreatography showed no anomaly of the biliary tree. Intraoperative findings revealed an accessory bile duct between the right hepatic duct and the cystic duct. A 36-year-old woman was found to have cholelithiasis. Cholecystectomy was performed to preserve an abnormal circuit of the CABD, which had been revealed on magnetic resonance cholangiopancreatography. By summarizing 36 previous case reports on CABD, we propose a new classification system of CABD as follows: type A, cystic duct type; type B, bile duct type; and type C, duplication type. Overall, 14 cases of type A, 20 cases of type B, and 2 cases of type C have been reported, including the present cases. In cholecystectomy for type A, resection of the circuit reduces the recurrence of cholelithiasis. In pancreaticoduodenectomy for type A and B, one can choose between one and two reconstructions of the extrahepatic duct.