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Extrahepatic bile duct duplication is a rare biliary anomaly often associated with conditions like cholecysto-choledocholithiasis, choledochal cyst and malignancy. Precise preoperative diagnosis using conventional radiologic imaging still remains a challenge and use of existing classification system is equally confusing. A female patient diagnosed with choledochal cyst by magnetic resonance cholangiopancreatography was found to have an associated new variant of double common bile duct during surgery. The variant discovered could not be classified by existing classification systems and was missed by preoperative imaging. Recognition of existence of this anomaly that warrants careful dissection during biliary surgery is necessary to avoid inadvertent biliary injury as preoperative diagnosis still remains a challenge. Review of existing classification systems is required to include newly discovered variants.

Duplicated common bile duct, often associated with conditions like lithiasis, biliary cysts and pancreatobiliary maljunction, could result in highly morbid and potentially fatal biliary injuries. Precise preoperative diagnosis and classification still remain a challenge. A female patient undergoing emergency laparoscopic cholecystectomy for acute calculous cholecystitis sustained iatrogenic bile duct injury. A drainage tube was placed into the injured duct for post-operative conservative management. Post-operative tube cholangiogram revealed a double common bile duct with cystic duct opening distally. This was identified as a new variant not previously reported or classified. However rare, duplicated common bile duct could result in serious iatrogenic bile duct injury if unidentified during surgery. Knowledge of its existence is essential to avoid such injuries as preoperative diagnosis still remains a challenge. A thorough clinical and morphological study of previously reported variants is needed for a comprehensive classification to encompass newly discovered variants.

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irresectable at surgery. The aim of the study was to identify factors associated with non-completion of curative-intended resection for pancreatic malignancy. Methods: All patients with suspected pancreatic malignancy deemed primarily resectable at a weekly MDT conference and scheduled for curative-intended surgery between January and December 2017, were identified from a prospective database. Parameters analyzed and compared for patients that were explored and resected and explored and not resected are depicted in the table. Results: Ninety patients were discussed at the MDT conference. Forty-three patients were considered primarily resectable and scheduled for surgery. Five (12%) did not undergo surgery due to death, disease progression or clinical deterioration. Of the 38 patients who underwent an operation, no resection was performed in 8 (21%) due to metastases (n = 4) or locally advanced disease (n = 4). Thirty patients were resected (27 pancreatico-duodenectomies, 1 central and 2 total pancreatectomies). Of all the parameters compared between resected and not resected patients, time from the MDT conference to surgery was the only parameter that was significantly different (11 versus 31 days, p < 0.01). Conclusions: In this pilot study conducted in a patient cohort treated in a resource-constrained environment, non-completion of curative-intended pancreatic surgery was strongly associated with a longer waiting time for surgery. This has important implications when prioritizing resources.