Low convergence of hepatic ducts: A rare extrahepatic biliary tree anatomical variation

Introduction: Low convergence of hepatic ducts is extremely rare. Here, the right and the left hepatic ducts course down towards the second part of the duodenum separately and converge just proximal to the ampulla of Vater, forming a short common bile duct. Case Series: We describe 2 cases of a 43-year-old male and a 53-yearold female with this anatomical anomaly who presented with obstructive jaundice. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated low convergence of the hepatic ducts. Both cases were associated with biliary ectasia and complicated with primary ductal stones. Excision of the anomalous extrahepatic bile ducts with hepaticoenterostomy was performed for one of the cases, however the other was lost to follow-up. Conclusion: Definitive operative intervention seems prudent despite the lack of consensus in the management of such anomaly, especially when there are concomitant biliary ectasia and ductal stones.