ANOMALOUS INSERTION OF THE RIGHT HEPATIC DUCT INTO THE CYSTIC DUCT. REPORT OF A CASE AND REVIEW OF THE LITERATURE

Abstract Background Laparoscopic cholecystectomy is a well-established surgical procedure and is one of the most commonly performed gastroenterological surgeries. Therefore, strategy for the management of rare anomalous cystic ducts should be determined. Case presentation A 56-year-old woman was admitted to our hospital owing to upper abdominal pain and diagnosed with acute cholecystitis. Magnetic resonance cholangiopancreatography suspected that several small stones in gallbladder and the right hepatic duct drained into the cystic duct. Endoscopic retrograde cholangiopancreatography confirmed the cystic duct anomaly, and an endoscopic nasobiliary drainage catheter (ENBD) was placed at the right hepatic duct preoperatively. Intraoperative cholangiography with ENBD confirmed the place of division in the gallbladder, and laparoscopic subtotal cholecystectomy was safely performed. Conclusions The present case exhibited rare right hepatic duct anomaly draining into the cystic duct, which might have caused biliary tract disorientation and bile duct injury (BDI) intraoperatively. Any surgical technique without awareness of this anomaly preoperatively might insufficiently prevent BDI, and preoperative ENBD would facilitate safe and successful surgery.

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Comparative Anatomical, Ultrasonographical and Radiological studies of the biliary system of Rabbits and Domestic cats in Egypt

10.1101/834408 ◽

2019 ◽

Author(s):

R.T. Reem ◽

M.A. Maher ◽

H.E. Alaa ◽

H.A. Farghali

Keyword(s):

Bile Duct ◽

Gall Bladder ◽

Cystic Duct ◽

Hepatic Duct ◽

Human Model ◽

Common Hepatic Duct ◽

Domestic Cats ◽

Left Hepatic Duct ◽

Right Lobe ◽

The Right

ABSTRACTUnder the prevailing overall Conditions of all veterinarians for the diagnosis of biliary diseases, application of surgical procedures and liver transplantation in Cats as carnivorous pet animal, and Rabbits as herbivorous pet animal and also as a human model in research. The present study was constructed on twelve native breeds of rabbits (Oryctolagus cuniculus) and eighteen adult domestic cats (Felis catus domesticus). We concluded that, in brief; the rabbit gall bladder was relatively small, fixed by several small hepato-cystic ducts to its fossa. The rabbit bile duct was formed commonly by the junction of the left hepatic duct and the cystic duct. The cystic duct was commonly fairly large, received the right hepatic duct that collected the right lobe in its route to enter the duodenum, the bile duct receives the branch of the caudate process of the caudate lobe. The present study revealed other four anatomic variations dealing with the shape and size of the feline native breed’s gall bladder from fundic duplication, bilobed, truncated fundus and distended rounded fundus. Commonly, the bile duct was formed by the triple convergence of the left and the right hepatic ducts with the cystic duct. However, in some exceptional cases a short common hepatic duct was formed. Sonographically, the normal gall bladder in rabbit appeared small, elongated with anechoic lumen bordered by right lobe laterally and quadrate lobe medially and has no visible wall, but in cat varied in conformation, bordered by the right medial lobe laterally and the quadrate lobe medially surrounded by echogenic wall.

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Surgical approach to a left-sided gallbladder

BMJ Case Reports ◽

10.1136/bcr-2019-230681 ◽

2019 ◽

Vol 12 (8) ◽

pp. e230681

Author(s):

Ryan Pereira ◽

Marlon Perera ◽

Matthew Roberts ◽

John Avramovic

Keyword(s):

Cystic Duct ◽

Imaging Modality ◽

Hepatic Duct ◽

Magnetic Resonance Cholangiopancreatography ◽

Falciform Ligament ◽

Biliary Colic ◽

Common Hepatic Duct ◽

Critical View Of Safety ◽

Symptomatic Gallstones ◽

The Right

Biliary colic is a pain in the right upper quadrant or epigastrium thought to be caused by functional gallbladder spasm from a temporary obstructing stone in the gallbladder neck, cystic duct or common bile duct. A 56-year-old man presented with frequent episodes of typical biliary colic. At initial laparoscopy, the gallbladder was absent from its anatomic location. Further inspection revealed a left-sided gallbladder (LSGB), suspended from liver segment 3. Preoperative ultrasound, the most common imaging modality for symptomatic gallstones, has a low positive predictive value for detecting LSGB (2.7%). Laparoscopic cholecystectomy (LC) was delayed to attain additional imaging. A magnetic resonance cholangiopancreatography demonstrated the gallbladder left of the falciform ligament with the cystic duct entering the common hepatic duct from the left. The patient underwent an elective LC 8 weeks later. The critical view of safety is paramount to safe surgical dissection and could be safely achieved for LSGB.

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A rare anatomical variation of the bile ducts: Cystic duct draining to the right hepatic duct

The Turkish Journal of Gastroenterology ◽

10.5152/tjg.2018.18321 ◽

2019 ◽

Vol 30 (4) ◽

pp. 375-376

Author(s):

Feyyaz Gungor ◽

◽

Yunus Sur ◽

Emine Ozlem Gur ◽

Osman Nuri Dilek ◽

...

Keyword(s):

Cystic Duct ◽

Bile Ducts ◽

Hepatic Duct ◽

Anatomical Variation ◽

The Right

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The Morphometry Extrahepatic Bile Ducts

ARS Medica Tomitana ◽

10.2478/arsm-2018-0038 ◽

2018 ◽

Vol 24 (4) ◽

pp. 184-189

Author(s):

Trantu Dina Elena ◽

Bordei Petru ◽

Ispas Viorel

Keyword(s):

Cystic Duct ◽

Extrahepatic Bile Duct ◽

Hepatic Duct ◽

Common Hepatic Duct ◽

Ct Scanner ◽

A Value ◽

Extrahepatic Bile Ducts ◽

Biliary Ducts ◽

The Common ◽

The Right

Abstract The extrahepatic bile duct morphometry was determined by the analysis of the colangiographies performed at Medimar Imaging Services SRL of the “St. Andrei “in Constanta on a General Electric Brightspeed Select CT scanner 16 slides. For the left liver duct found a caliber of 3.5-6.6 mm, its length ranging from 4.2-24.9 mm, and the right hepatic duct had a caliber ranging from 4.2-7.2 mm, the length being between 3.0-25.0 mm. At the confluence of the two hepatic ducts an angle of 35.0-124.1° was formed. In the common hepatic duct we found a caliber of 3.9-9.7 mm, in length between 20.2-52.9 mm. Cystic duct having a size of 2.4 to 5.5 mm, finding a length ranging from 24.6 to 66.4 mm. The angle formed at the end of the cystic duct in the hepatic duct had a value between 6.2-55.8°, and between the cystic and biliary ducts an angle of between 88.5-170.4° was formed. The coledoc duct had a caliber of 3.1-14.7 mm and a length of 19.8-57.3 mm.

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Magnetic Resonance (MR) Cholangiopancreatography Demonstration of the Cystic Duct Entering the Right Hepatic Duct

American Journal of Case Reports ◽

10.12659/ajcr.902620 ◽

2017 ◽

Vol 18 ◽

pp. 242-245 ◽

Cited By ~ 1

Author(s):

Tommaso D\'Angelo ◽

Sergio Racchiusa ◽

Silvio Mazziotti ◽

Giuseppe Cicero

Keyword(s):

Magnetic Resonance ◽

Cystic Duct ◽

Hepatic Duct ◽

Mr Cholangiopancreatography ◽

The Right

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Where to incise and/or divide the cystic duct

Acta chirurgica iugoslavica ◽

10.2298/aci0201099i ◽

2002 ◽

Vol 49 (1) ◽

pp. 99-101 ◽

Cited By ~ 1

Author(s):

D. Ignjatovic ◽

B. Djuric ◽

V. Zivanovic

Keyword(s):

Laparoscopic Cholecystectomy ◽

Cystic Duct ◽

Hepatic Duct ◽

Common Hepatic Duct ◽

Corrosion Casting ◽

Post Mortem ◽

Spiral Valve ◽

Human Cadavers ◽

The Common ◽

The Right

The study concern was to establish the position of cystic duct incision/division in circumstances of laparoscopic cholecystectomy. Seventy consecutive human cadavers were dissected. Corrosion casting (50) and post-mortem cholangiography (20) were employed. Cystic duct length was 34.6 mm, and in 88.6 % cases its length was 1-5 cm. Mean cystic duct diameters next to the gallbladder neck, within the valve and 5 mm proximal to the junction with the common hepatic duct were 1.95, 0.42 and 1.85 mm, respectively. Lateral cystohepatic junction was identified in 78.6%, spiral in 10% and parallel in 10%. In 90% cases the cystohepatic junction is within 4 cm of the hepatic duct junction. One case (1.43%) of cystic duct entering the right hepatic duct was identified. The valve of Heisteri consisted of three spiral turns in 73% of the cases with a range from 0 to 5. In 3/70 specimens the spiral valve did not exist.

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Clinical aspects and surgical technique in Mirizzi syndrome: A systematic review

International Journal of Development Research ◽

10.37118/ijdr.18563.05.2020 ◽

2020 ◽

pp. 35871-35873

Keyword(s):

Surgical Technique ◽

Cystic Duct ◽

Hepatic Duct ◽

Signs And Symptoms ◽

Mirizzi Syndrome ◽

Common Hepatic Duct ◽

Clinical Aspects ◽

Main Diagnosis ◽

Biliary Surgery ◽

Electronic Library

Mirizzi syndrome is described in the 1940s as follows: partial obstruction of the secondary common hepatic duct by gallstones, impacted on the cystic duct or gallbladder infundibulum, associated with the inflammatory response that involved the cystic duct and the common hepatic duct. As it is a rare and delicate condition, differential diagnosis is extremely important, in which the patient's clinical condition is verified through anamnesis and complementary exams, where immediately after the surgical intervention can be performed. This work aims to describe, through a literature review, the clinical aspects and the surgical technique in Mirizzi Syndrome. Were used as a database for research sites containing scientific articles available online such as Virtual Health Library (VHL), Scientific Electronic Library Online (Scielo) and PubMed. 154 articles were found through the descriptors, where after applying the inclusion and exclusion criteria 11 articles remained to write the work. According to the articles surveyed, it is clear that most of them do not report the syndrome as the main diagnosis, possibly because it is a pathology with signs and symptoms very close to other diseases of the bile duct, therefore leaving the syndrome sometimes described in the context of these other diseases. Finally, it concludes that even though the preoperative diagnosis is rare, it should be suspected in individuals undergoing biliary surgery.

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