Retrograde Laparoscopic Cholecystectomy with Megacystic Duct and Dense Adhesions following recurrent Cholangitis with Biliary Obstruction

Difficult laparoscopic cholecystectomy may result from dense adhesions, distorted anatomy, and recurrent biliary inflammation. A fundus-first (retrograde) approach can serve as a bailout strategy when safe dissection of the hepatocystic triangle is difficult.
Case Presentation:
A 63-year-old woman presented with recurrent episodes of common bile duct obstruction and cholangitis. Preoperative ultrasonography demonstrated a dilated common bile duct measuring approximately 10 mm , while MRCP showed persistent CBD dilatation without current obstruction. At laparoscopy, extensive adhesions and difficult anatomy prevented safe initial approach to the cystic duct. A retrograde fundus-first cholecystectomy was therefore performed. During dissection, the gallbladder was entered and its contents evacuated, facilitating further mobilization. Progressive dissection toward the infundibulum improved exposure of the hepatocystic triangle. A markedly dilated cystic duct, appearing greater than 1 cm in diameter intraoperatively, was identified and carefully managed. Minor bleeding was successfully controlled, and the procedure was completed laparoscopically without further complications.
Conclusion:
The fundus-first approach can provide a useful bailout strategy in difficult cholecystectomy and facilitate safe management of markedly dilated cystic duct anatomy.