Doble colédoco, variante anatómica infrecuente de la vía biliar. Presentación de caso / Double common bile duct, a rare anatomical variant of the bile tract. Case report

Introducción: la presencia de un conducto colédoco doble es una variante anatómica infrecuente con menos de 200 casos publicados en la literatura hasta la fecha, siendo fundamental los estudios preoperatorios que se le deben realizar a los pacientes, a fin de tener la sospecha o el diagnóstico confirmado, no sólo de la variante anatómica, sino de la patología asociada, siendo estas la coledocolitiasis y las patologías malignas del árbol biliar las más frecuentes, aunque gran parte de los casos son hallazgos incidentales e intraoperatorios.Caso clínico : se presenta el caso de masculino de 81 años de edad, con antecedente de colecistectomía 20 años previos, con diagnóstico de síndrome ictérico obstructivo, y estudios de colangiorresonancia y CPRE que reportan coledocolitiasis. Se decide llevar a acto quirúrgico y se diagnóstica la presencia de conducto colédoco doble como hallazgo. Se realiza derivación biliodigestiva de tipo hepaticoyeyunoanastomosis más ligadura de conducto colédoco accesorio con evolución satisfactoria, con alta médica a los 5 días posteriores, y resultado de biopsia negativo para malignidad.Conclusión : el doble colédoco debe ser adecuadamente diagnosticado y estudiado, así no se confirme el diagnóstico preoperatorio los pacientes deben acudir con estos estudios realizados al acto quirúrgico, ya que, dicho tratamiento dependerá fundamentalmente de la patología asociada(AU)

Introduction: the presence of a double common bile duct is an infrequent anatomical variant with less than 200 cases published in the literature to the date, and preoperative studies that must be performed on patients are essential in order to have the suspicion or diagnosis confirmed, not only of the anatomical variant, but also of the associated pathology, these being choledocholithiasis and malignant pathologies of the biliary tract the most frequent, although most of the cases are incidental and intraoperative findings.Clinical case : the case of an 81-year-old male is presented, with a history of cholecystectomy 20 years prior, with a diagnosis of obstructive icteric syndrome, and magnetic resonance cholangiography and ERCP studies that reported choledocholithiasis. It was decided to carry out surgery and the presence of double common bile duct was diagnosed as a finding. Biliodigestive derivation hepaticojejunoanastomosis type and accessory common bile duct ligation was performed with satisfactory evolution, with medical discharge 5 days later, and biopsy result negative for malignancy.Conclusion : the double common bile duct should be properly diagnosed and studied, even if the preoperative diagnosis is not confirmed, patients should attend the surgical procedure with these studies, since said treatment will depend fundamentally on the associated pathology(AU)

Opciones terapéuticas actuales en el manejo de la coledocolitiasis asociada a colecistolitiasis / Current therapeutic options in the management of choledocholithiasis associated with cholecyllithiasis

The term Choledocholithiasis refers to the presence of biliary stones in the extrahepatic bile ducts, which are found in 5 to 10% of patients undergoing cholecystectomy for gallstones. Nowadays, with the adoption of the laparoscopic cholecystectomy(LC) as a standard, multiple minimally invasive treatment options for bile duct stones are feasible, with no consensus to date on the procedure of choice. The two stage endoscopic techniques involve the use of Endoscopic Retrograde Cholangiopancreatography(ERCP) before or after performing a LC, which has the main advantage of separating the bile duct procedure from the LC. However, the need for two separate anesthesia times, the possibility of blank or failed ERCP, and the chance for calculi migration between procedures increase the length of hospital stay and associated costs. The single stage procedures include the Laparoscopic Bile Duct Exploration (LBDE), and more recently, the performance of a laparoscopy guided intraoperative ERCP(Rendez Vous). The LBDE, when performed by an experienced surgical team, is an effective and safe technique. Nonetheless, it is considered a technically demanding procedure, whose results cannot be extrapolated to the general surgical community. Recently, the Rendez Vous has become a treatment alternative that simplifies both the surgical and the endoscopic procedures, decreases morbidity, and requires a single anesthesia time. On the downside, Rendez Vous technique involves complex operating room (OR) logistics, requiring both a trained surgical and endoscopic team at the same time. (AU)