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The biliary system is well known for its anatomical variability. Precise imaging and evaluation of the cystic duct are essential for surgeons and interventional radiologists. Herein we reported a rare case of cystic duct variation. Coronal oblique 3D magnetic resonance cholangiopancreatography (MRCP) revealed a posterior spiral course of the cystic duct, with a medial spiral insertion into the middle part of the extrahepatic bile duct. Intraoperative cholangiography confirmed this finding. Specific anatomical variations might require modifications to the surgical approach. Understanding the cystic duct anatomy, variants, and disease processes aids in better diagnosis and interpretation of imaging results. MRCP is essential for providing key anatomical information and helps to reduce the risk of complications during percutaneous, endoscopic, and surgical procedures.

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