GI IMAGE Common Bile Duct Duplication Type Va. A Rare but Important Anatomical Variation to Know María Rita Rodríguez-Luna 1 & Joaquin E Guarneros-Zárate 2 & Victor Manuel Noriega-Usi 3 & Rosa Margarita Terron-Arriaga 4 & Jose Fenig Rodríguez 5 Received: 4 July 2017 /Accepted: 10 July 2017 # 2017 The Society for Surgery of the Alimentary Tract Keywords Common bile duplication . Biliary anatomic variations . Cholecystectomy . Cholangiogram Clinical Case Twenty-seven-year-old female patient with 1-month intermit- tent colic pain in right upper quadrant associated with food in- gestion, without jaundice, dark urine, or pale stools. Physical examination revealed mild tenderness in the epigastrium and right upper quadrant, positive Murphy sign. Her liver blood test with GGT 280 UI/L, AST 70 mg/Dl, ALT 90 mg/Dl, ALP 180 UI/L. Abdominal ultrasound showed a distended gallbladder with multiple hyperechogenic images with posterior acoustic shadow, common bile duct of 5 mm, and portal vein diameter of 7 mm without intrahepatic bile dilatation. The patient denied any symptoms in the past, weight loss, or family history of can- cer. She underwent laparoscopic cholecystectomy. Intraoperative cholangiogram was performed to rule out common bile duct obstruction due to preoperative hepatic enzymes alteration. The transcystic intraoperative cholangiogram (Fig. 1) showed common bile duct duplication without signs of biliary obstruction. The biliary tract is one of the anatomic structure with most variations in the human body. 1 With that said, com- mon bile duct duplication is exceedingly rare. This anatomic abnormality can be classified in five types according to Saito, modified by Choi et. al. 2 The common bile duct duplication type V is considered the rarest of all. Our case is a Va type in which there is a duplication of extrahepatic bile ducts opening into a short common bile duct, that drains into the hepatopancreatic ampulla. To our knowl- edge, this is the first case of a Va common bile duplication reported in Mexico. Fig. 1 Transcystic intraoperative cholangiogram * María Rita Rodríguez-Luna rita.rodriguez.md@gmail.com 1 PGY4 General Surgery, Hospital Angeles Mocel, Facultad Mexicana de Medicina, Universidad La Salle, Gelati 29 Colonia San Miguel Chapultepec Miguel Hidalgo CP, 11850 Ciudad de México, Mexico 2 General Surgery, Hospital Angeles Mocel, Mexico City, Mexico 3 General Surgery, Endoscopic Surgery, Hospital Angeles Mocel, Hospital Centro Medico American British Cowdray, Mexico City, Mexico 4 PGY2 General Surgery, Hospital Angeles Mocel, Facultad Mexicana de Medicina, Universidad La Salle, Mexico City, Mexico 5 General Surgery, Hospital Angeles Mocel, Surgical Residency Program, Facultad Mexicana de Medicina, Universidad La Salle, Mexico City, Mexico J Gastrointest Surg DOI 10.1007/s11605-017-3505-z