case_images: PMC10867158_01
case_images: The abdominal MRI scan (A) showing the right hepatic bile duct (yellow arrow), a fistula between the right hepatic duct and the duodenal bulb (red arrow), and a low confluence of the right hepatic duct into the common bile duct (white arrow). Three-dimensional cholangiography (B) showing the right anterior hepatic duct, right posterior hepatic duct, right hepatic duct, and an abnormal opening with stenosis in the right hepatic duct. The abdominal CT scan (C) revealed the presence of gas within the right intrahepatic duct (black arrow).
case_images: fmed-11-1346590-g001.jpg
case_images: PMC10867158_01_fmed-11-1346590-g001.jpg
case_images: fig1
case_images: Three-dimensional biliary tract reconstruction displayed stenosis at the onset of the right hepatic duct, dilation of the right intrahepatic bile duct, with no anomalies in the left hepatic duct and common bile duct (Figure 1).
case_images: The duodenal bulb adheres to the hepatic hilum (A). A puncture was made in the right hepatic duct, and bile was aspirated. The sinus tract was sharply dissected open (B), which revealed the openings of the right anterior and posterior hepatic ducts (blue arrow), as well as a fistula leading to the duodenum (green arrow).
case_images: fmed-11-1346590-g002.jpg
case_images: PMC10867158_01_fmed-11-1346590-g002.jpg
case_images: fig2
case_images: Upon incision and exploration, the sinusoidal tract was found to connect the right bile duct and duodenal lumen, confirming the presence of a right hepatic duct-duodenal internal fistula (Figure 2).
case_images: Preoperatively (A), the right hepatic duct communicated with the bulb of the duodenum (red arrow), and the biliary tree of the right side of the liver was dilated. Postoperatively (B), The Rouxen-Y right hepatic duct-jejunum anastomosis (yellow arrow) restore the normal anatomical relationship between the duodenal bulb and the right hepatic duct, and the dilation of the biliary tree in the right side of the liver improved.
case_images: fmed-11-1346590-g003.jpg
case_images: PMC10867158_01_fmed-11-1346590-g003.jpg
case_images: fig3
case_images: After 1 month post-surgical procedure, a follow-up MRI + MRCP exhibited alleviation of right intrahepatic bile duct dilation (Figure 3).