Accessory Cystic duct with CBD calculus

The gall bladder has been excised. There is mild to moderate dilation of the intrahepatic biliary radicles. The CHD and CBD measure 12 mm. The distal end of the CBD reveals a hypointense filling defect consistent with a calculus. There is a thin serpiginous cystic tract from the medial aspect of the distal CBD , going posterio-superiorly and ending blind. There are pockets of intraperitoneal fluid in the right upper quadrant ,and a drainage tube is visible. There is minimal dilation of the 2nd to 4th parts of the duodenum and jejunal loops, likely due to ileus. E.R.CP. was performed to remove the stone.

Residual stone in the distal CBD after cholecystecomy.

An accessory cystic duct is identified which is the most probable cause of bile leakage into the drainage tube.