Cholecysto Hepatic Duct (original) (raw)
Case Reports in Radiology
Although relatively infrequent, bile duct leaks are among the primary complications of hepatobiliary surgery and cholecystectomy given the large number of these operations performed annually around the world. Variant biliary anatomy increases the risk of surgical complications, especially if unrecognized on preoperative imaging or intraoperatively. Presented here is a case of a patient with an unrecognized cholecystohepatic duct at the time of surgery leading to bile leak after cholecystectomy. Numerous factors made for a technically difficult surgery with obscuration of the true anatomy, ultimately resulting in transection of the cholecystohepatic duct. Understanding normal and variant biliary anatomy will help prevent avoidable complications of hepatobiliary surgery.
Hepaticocystic Duct in an Era of Laparoscopic Cholecystectomy
The Surgery Journal, 2021
The biliary tract is notorious for its variable anatomy. A persistent hepaticocystic duct with agenesis of common bile duct is a rare biliary anomaly that creates a diagnostic dilemma and can add to the operative difficulties. It is important to diagnose this anomaly preoperatively since the gallbladder forms an integral part of bilioenteric continuity and an inadvertent cholecystectomy can lead to a surgical catastrophe. If diagnosed, surgeons can plan definitive treatment in the form of biliary diversion. We present a case of a 22-year-old man, who presented to us with obstructive jaundice and cholangitis. The biliary system was decompressed initially with a percutaneous transhepatic biliary drainage and an endoscopic retrograde cholangiogram established the diagnosis of a type IV hepaticocystic duct preoperatively in our case. Since diagnosis was made prior to operative intervention, we were able to perform a cholecystojejunostomy to maintain biliary continuity. The patient was d...
Variations of the Extrahepatic Biliary Tract: Cadaveric Study
IOSR Journal of Dental and Medical Sciences, 2013
The extra-hepatic biliary tract includes: right and left hepatic ducts, common hepatic duct, gallbladder, cystic duct and common bile duct. The variation in this system is seen in less than 50% of the cases. This study was carried out to describe the anatomical variations of the extra-hepatic biliary tract as these variations are important during surgical procedures such as laparoscopic cholecystectomy thereby decreasing the post-operative complications.
Surgical and Radiologic Anatomy, 2001
A rare abnormal biliary tract consisting in a double common bile duct with an ectopic biliary tree draining into the stomach is described. This congenital anomaly, associated with lithiasis in the ectopic duct, was detected for the first time on MR -cholangiopancreatography. Only 23 cases of abnormal biliary drainage into the stomach have been reported in the literature. Embryogenesis and potential risks, such as lithiasis in the ectopic duct and the development of gastric carcinoma, are discussed.
Low convergence of hepatic ducts: A rare extrahepatic biliary tree anatomical variation
International Journal of Hepatobiliary and Pancreatic Diseases, 2015
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
2003
Bile duct injuries have been recorded with open cholecystectomy (OC) long before the introduction of laparoscopic cholecystectomy (LC) (Lillemoe et al, 2000). The introduction of OC by Langenbuch of Berlin in 1882 brought about the world wide use of OC for the management of symptomatic gall stones. After that, injuries to the biliary tree became a recognized complication of operation (Roslyn et al, 1993). Over the last decade, the incidence of bile duct injuries after OC has been estimated at 0.1% to 0.3% (Edmond and Marvin, 2001).
Duplicated extrahepatic bile duct (type Vb): An important rare anomaly
Annals of Hepato-Biliary-Pancreatic Surgery
Congenital duplication of the extrahepatic bile duct (DEBD) is an unusual anomaly of the biliary system. It occurs due to inability of the embryological duplex biliary system to regress. DEBD has various subtypes depending on the morphology and opening of the aberrant common bile duct. It can have distinct complications. We encountered a 38-year-old lady who experienced pain in the right upper abdomen along with a low-grade fever. Magnetic resonance cholangiopancreatography revealed DEBD with multiple calculi in the right hepatic duct (ductolithiasis) and joining of the right hepatic duct with the left hepatic duct in the intrapancreatic region. Endoscopic retrograde cholangiography failed to clear the calculi from the right duct. They were then managed by common bile duct exploration and roux-en-Y right hepaticojejunostomy for biliary drainage. Her postoperative period was uneventful. She is currently doing well after three months of follow-up. Hence, a proper preoperative delineation of such rare anomalies is essential. It could avoid inadvertent injury to the bile duct and operative complications.
Journal of Translational Medicine and Research, 2016
Background: In the current era, the laparoscopic procedure such as laparoscopic cholecystectomy, laparoscopic hepatobiliary surgery and other open procedures such as open cholecystectomy, biliary stricture surgery, are performed regularly throughout the world and extrahepatic biliary tract is one of the most common sites of the surgical procedures. The incidence of biliary tract injury by laparoscopic cholecystectomy has been found to be higher than open cholecystectomy. Apart from various other causes of biliary injuries aberrant anatomical course of extrahepatic biliary system is a well established fact of iatrogenic ductal injury. Thus, an adequate recognition and awareness of anatomical abnormalities of extra hepatic biliary tree with its vessel, can decrease the morbidity and mortality related to the surgery. Methods: Study was done in Department of Surgery, Gandhi Medical College and Hamidia Hospital Bhopal, India on 100 cases, during period of Aug 2014 to Nov 2015, and dissection was carried out in department of Forensic Medicine and Toxicology after taking permission from ethical committee. Results: In 100 cases of study 72 were male and 28 were female in which 16% male and 10.7% female showed variations in their anatomy. The most common variation which we observed in our study was short cystic duct in 8 cases, and second most common variations was cystic artery origin, from left hepatic artery in 3 cases and from proper hepatic artery in 1 case, other variations were floating gall bladder in 1 case, intrahepatic union of left hepatic duct and right hepatic duct in 3 cases, low insertion of cystic duct in 3 cases, high insertion of cystic duct to common hepatic duct in 1 case,and in one case cystic artery passing anterior to common hepatic duct. Conclusion: There was a significant variations seen in extrahepatic biliary apparatus and its related arterial supply in our study, and these variations observed could definintely be useful to hepatobiliary, laparoscopic surgeons and radiologist. And will further contribute to literature available on variations of extrahepatic biliary system.
Complete biliary obstruction without jaundice due to an anatomic variation
The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology, 2014
An aberrant right posterior hepatic duct is present in 4.8-8.4% of the population. It is one of the causes of bile duct injury during laparascopic cholecystectomy. Herein we present a patient with complete transection of the common hepatic duct during laparascopic cholecystectomy (Stewart-Way class 3). Interestingly, the patient had an intact aberrant right posterior duct draining into the common hepatic duct distal to the obstruction site that prevented early diagnosis of the biliary injury because of drainage of the liver sufficient to prevent the development of jaundice.
Clinical Journal of Surgery, 2020
The anatomy of the bile duct is frequently subject to alterations, to which digestive surgeons should be attentive during a gallbladder or bile duct intervention. We present an unusual case of a malformation which, to the best of our knowledge, has not been described previously. In this case, two ducts emerged from the right bile duct, discharging into a bile lake within the gallbladder bed. The patient was an 80-year-old male who had undergone cholecystectomy after an episode of pancreatitis. During the procedure (and confirmed by cholangio-Nuclear Magnetic Resonance), a bile lake was observed within the gallbladder bed, which was connected to the fundus of the gallbladder. The situation was resolved by carefully dissecting the gallbladder bed and subsequently clipping and resecting the communicating duct. In performing surgical interventions affecting the bile ducts, it is important to be aware of the anatomical variants that may be encountered. We present a clinical case which, to the best of our knowledge, has not been described previously. In our opinion, the possible existence this kind of anatomical variant should be taken into account, to avoid potentially severe injury.
Duplication of extrahepatic bile duct: A Challenge to Surgeons
International Journal of Health Sciences and Research, 2016
Biliary anatomical variation is a common variation seen in human body but duplication of extrahepatic bile duct is rare. Precise knowledge of this variation helps in preventing serious complications during surgery of the biliary tract. The present article reviews this rare anomaly and its management.
International Journal of Surgery Case Reports, 2017
INTRODUCTION: Aberrant subvesical bile ducts are a scarce anatomical variation, consisted by a network of bile ducts located in the peri-hepatic capsule of the gallbladder fossa. These rare ducts are usually discovered intraoperatively and their presence poses the risk of bile injury and clinically significant bile leak. PRESENTATION OF CASE: Aberrant subvesical bile ducts were unexpectedly identified in a young woman during laparoscopic cholecystectomy. These three ducts were clipped carefully for avoidance of bile duct injury and subsequent bile leak. The operation was uneventful. A meticulous review of the recent literature was conducted as well. DISCUSSION: This unusual anatomical variation of the biliary tract is mainly discovered during the operation. Thus, surgical injury of these ducts is nearly inevitable and it provokes the severe complication of bile leak. Bile injury represents the most crucial and life-threatening postoperative complication of cholecystectomies. Surgeons in the right upper quadrant of the abdomen should be constantly aware of this rare anatomical variation. CONCLUSION: Aberrant subvesical bile ducts are associated with a high risk of surgical bile duct injury. Nevertheless, meticulous operative technique combined with surgeons' perpetual awareness concerning this peculiar anatomical aberration leads to a safe laparoscopic cholecystectomy.
Journal of Academic Research in Medicine, 2015
The anatomy and the potential variations of bile ducts are required to be known to prevent possible complications before laparoscopic hepatobiliary surgical interventions. There are many congenital variations at intrahepatic and extrahepatic bile ducts. Together with the increase in experience, the rate of complications have been declined to 0.5% from the first laparoscopic cholecystectomies. In this case study, we found out anatomical variations during the laparoscopic surgery of a case with bile stone-induced chronic cholecystitis and shortly reviewed the literature about the anatomical variations of bile ducts.
Background Variations of the hepatico-pancreatic-biliary system are frequently vascular, but biliary duct deviations can occur. In the extra-hepatic biliary system, anomalies occur during foregut development and include accessory ducts, anomalous insertions, or agenesis. Though anomalies may be clinically silent, discovery usually occurs in symptomatic patients resulting in imaging or intraoperatively during exploration. The rarest of anomalies is common bile duct agenesis, resulting in formation of a cholecystohepatic duct, gallbladder interposition, or perhaps most appropriately, a hepaticocystic duct. We present here two cases discovered intraoperatively and an updated review on this anomaly.
Biliary ductal variations and its clinical implications: a cadaveric study
International Journal of Research in Medical Sciences
Background: Biliary ductal region being frequently abnormal has been the subject of research since long time for anatomists, surgeons and radiologists as well.Methods: The present study was carried out in the department of Anatomy at PGIMS, Rohtak on 50 specimens of liver taken unblock with associated structures.Results: Accessory hepatic and accessory cystic ducts were observed in 4% cases each. 2% cases exhibited abnormal low fusion of cystic duct with common hepatic duct.Conclusions: These anomalies may add to postoperative complications if ignored. Present study is a step in the direction of creating awareness about these variations among the clinicians.
Interposition of the gallbladder in the common hepatic duct: a rare dangerous anomaly. Case report
Il Giornale di chirurgia
Anomalies of the gallbladder position in the biliary tract are rare, but they could be very dangerous during cholecystectomy. A 48-year-old man presented with a 2-week history of intermittent epigastric pain, scleral jaundice and elevation of liver function tests. After a magnetic resonance cholangiogram and an endoscopic retrograde cholangiogram with sphincterotomy, he was submitted to laparoscopic cholecystectomy, the conversion to laparotomy was decided for the suspect of gallbladder interposition. The anatomical anomaly was confirmed and a Roux-en-Y hepaticojejunostomy was executed, with end-to-side anastomosis between the confluence of the hepatic ducts and the fourth loop of jejunum, on a biliary stent. This catheter was removed in the tenth postoperative day; after cholangiography and CT abdominal scan the patient was discharged, without complications. The gallbladder interposition is a rare malformation which seems to arise from an embryonic anomaly occurring between the 4th...
Congenital Cystic Lesion In Extra Hepatic Biliary Tract
2019
Objective: To illustrate congenital cystic lesions of the extra hepatic biliary tract on the idea of information of embryologic development through the magnetic resonance cholangiopancreatography (MRCP). Methods: Patients that were suspected to have been suffering from biliary disease were referred to the MRI units, there the patients were narrowed done to confirm with the inclusion and exclusion criteria, thereafter written and informed consent was obtained from them and the procedure was explained to them in detail. MRCP was performed on a 1.5 Tesla in MR unit, using phased-array coil for signal detection. Heavily T2 weighted images were obtained with SSF-SE technique. The axial sections were used for pancreatic and bile ducts whereas the coronal sections were used for the pancreatobiliary tract, axial and coronal source images and reformatted images were evaluated together for the possibility of any anomaly in extra hepatic biliary tract. This was an observational, cross sectiona...