PubMed · 8408354
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P B Warfield. 1993-09-30. One procedure or two?. https://pubmed.ncbi.nlm.nih.gov/8408354/
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A patient with symptomatic cholecystolithiasis underwent laparoscopic cholecystectomy after confirmation of the diagnosis by sonography. Intraoperative cholangiography was normal and the operation was completed laparoscopically. Due to the postoperative persistence of right upper abdominal pain, another sonogram and then an endoscopic retrograde cholangiogram (ERCP) were performed. To our surprise, an accessory gallbladder with a remaining gallstone was revealed. The accessory cystic duct was shown as arising directly from the right hepatic duct. The patient underwent a second laparoscopic cholecystectomy, but due to hemorrhaging the operation had to be converted to an open procedure. The two gallbladders and their corresponding cystic ducts and arteries were entirely separate. To our knowledge, this is the first publication of a duplicate gallbladder where the cystic duct arose directly from the right hepatic duct.
Gastrointestinal endoscopy comprises gastroscopy, colonoscopy, and endoscopic retrograde cholangiopancreatography (ERCP). Endoscopic ultrasonography and small bowel enteroscopy are also available, although not in all endoscopy units. The diagnostic accuracy of gastrointestinal endoscopy is very high. Scientific activities include evaluation of methods/regimens where diagnostic gastroscopy can be replaced by non-invasive Helicobacter screening for certain patients, the use of non-invasive alternatives to ERCP (e.g. magnetic resonance), small bowel enteroscopy without the use of an endoscope, and virtual colonoscopy with computer tomography or magnetic resonance techniques. The move away from traditional endoscopic procedures towards more non-invasive techniques is taking place along with the development of new endoscopic procedures to replace traditional surgical techniques, e.g. endoscopic placement of colonic metal stents in acute colonic obstruction.
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