Introduction : Cystic duct variation is quite common, but a single gallbladder with double cystic duct is an extremely rare variant. These variations increase risks of duck injury or bile leakage unless it was diagnosed preoperatively or intraoperatively.

Methods : We report a case of choledocholithiasis in a patient with a cholangitis and cholecystitis who was intraoperatively diagnosed double cystic duct and successfully treated with laparoscopic cholecystectomy.

Results : A 72-year old man was admitted to our hospital due to epigastric pain and fever. He presented with right upper quadrant tenderness and positive Murphy’s sign. Total bilirubin, direct bilirubin, liver function test was elevated with leukocytosis. Cholangitis with distal common bile duct stone and gallbladder stone was diagnosed by computed tomography. Endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy was performed with removal of CBD stone and sludges. ERCP revealed normal bile duct anatomy. Under general anesthesia, four ports elective laparoscopic cholecystectomy was done and double cystic duct was found. During operation we ligated cystic duct and cystic artery, more dissection was done for removal pericholecystic connective tissue from hilum. Non pulsatile tubular structure was observed from liver hilum to gallbladder. It was ligated and divided after fully dissected. Postoperatively magnetic resonance cholangiopancreatography revealed that CBD was not injured neither leaked.

Conclusions : Double cystic duct with single gallbladder is a very rare anomaly. Although preoperatively image does not reveal this variation, laparoscopic cholecystectomy could be done safely and intraoperative cholangiogram should be considered to prevent ductal injury.