Leakage Via Aberrant Bile Duct Due
to Cholangiocarcinoma

The case of a male who had an open cholecystectomy complicated by presistent bile leak from an aberrant bile duct is presented. The persistence and volume of bile leak resulted in subsequent investigation of the biliary tree which demonstrated a cholangiocarcinoma of the right hepatic duct. This case is presented as an unusual presentation of cholangiocarcinoma and to highlight the value of modern techniques in imaging the biliary tree.

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Iatrogenic Bile Duct Injury Associated with Anomalies of the Right Hepatic Sectoral Ducts: A Misunderstood and Underappreciated Problem

HPB Surgery ◽

10.1155/2009/153269 ◽

2009 ◽

Vol 2009 ◽

pp. 1-4 ◽

Cited By ~ 18

Author(s):

Nitin Babel ◽

Sujit V. Sakpal ◽

Prakash Paragi ◽

Jason Wellen ◽

Stephen Feldman ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Bile Duct Injury ◽

Bile Ducts ◽

Hepatic Duct ◽

Open Cholecystectomy ◽

Standard Of Care ◽

Number Of Patients ◽

The Right ◽

Iatrogenic Bile Duct Injury

Although laparoscopic cholecystectomy (LC) has been widely accepted as the standard of care, it continues to have a higher complication rate than open cholecystectomy. Bile duct injury with LC has often been attributed to surgical inexperience, but it is also clear that aberrant bile ducts are present in a significant number of patients who sustain biliary injuries during these procedures. We present three cases of right sectoral hepatic duct injuries which occurred during LC and provide a discussion of the conditions which are likely to lead to these injuries, as part of a strategy to prevent them.

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Extraluminal recanalization for postoperative biliary obstruction using transseptal needle

Surgical Case Reports ◽

10.1186/s40792-020-01080-9 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Hiroki Horinouchi ◽

Eisuke Ueshima ◽

Keitaro Sofue ◽

Shohei Komatsu ◽

Takuya Okada ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Bile Duct ◽

Biliary Obstruction ◽

Hepatic Duct ◽

Drainage Tube ◽

Biliary Strictures ◽

Hepatic Bile ◽

Hepatic Bile Duct ◽

Benign Biliary Strictures ◽

The Right

Abstract Background Postoperative biliary strictures are commonly related to accidental bile duct injuries or occur at the site of biliary anastomosis. The first-line treatment for benign biliary strictures is endoscopic therapy, which is less invasive and repeatable. However, recanalization for biliary complete obstruction is technically challenging to treat. The present report describes a successful case of treatment by extraluminal recanalization for postoperative biliary obstruction using a transseptal needle. Case presentation A 66-year-old woman had undergone caudal lobectomy for the treatment of hepatocellular carcinoma. The posterior segmental branch of the bile duct was injured and repaired intraoperatively. Three months after the surgery, the patient had developed biliary leakage from the right hepatic bile duct, resulting in complete biliary obstruction. Since intraluminal recanalization with conventional endoscopic and percutaneous approaches with a guidewire failed, extraluminal recanalization using a transseptal needle with an internal lumen via percutaneous approach was performed under fluoroscopic guidance. The left lateral inferior segmental duct was punctured, and an 8-F transseptal sheath was introduced into the ostium of right hepatic duct. A transseptal needle was advanced, and the right hepatic duct was punctured by targeting an inflated balloon that was placed at the end of the obstructed right hepatic bile duct. After confirming successful puncture using contrast agent injected through the internal lumen of the needle, a 0.014-in. guidewire was advanced into the right hepatic duct. Finally, an 8.5-F internal–external biliary drainage tube was successfully placed without complications. One month after the procedure, the drainage tube was replaced with a 10.2-F drainage tube to dilate the created tract. Subsequent endoscopic internalization was performed 5 months after the procedure. At the 1-year follow-up examination, there was no sign of biliary obstruction and recurrence of hepatocellular carcinoma. Conclusions Recanalization using a transseptal needle can be an alternative technique for rigid biliary obstruction when conventional techniques fail.

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Proximal Extrahepatic Bile Ducts: Comprehensive Review

Journal of oncology: diagnostic radiology and radiotherapy ◽

10.37174/2587-7593-2021-4-1-74-93 ◽

2021 ◽

Vol 4 (1) ◽

pp. 74-93

Author(s):

M. A. Shorikov ◽

O. N. Sergeeva ◽

M. G. Lapteva ◽

N. A. Peregudov ◽

B. I. Dolgushin

Keyword(s):

Bile Duct ◽

Bile Flow ◽

Bile Ducts ◽

Extrahepatic Bile Duct ◽

Hepatic Duct ◽

Biliary Tree ◽

Comprehensive Review ◽

Extrahepatic Bile Ducts ◽

And Function ◽

Variant Anatomy

Proximal extrahepatic bile ducts are the biliary tree segment within formal boundaries from cystic ductcommon hepatic duct junction to sectoral hepatic ducts. Despite being a focus of attention of diagnostic and interventional radiologists, endoscopists, hepatobiliary surgeons and transplantologists they weren’t comprehensively described in available papers. The majority of the authors regard bile duct confluence as a group of merging primitively arranged tubes providing bile flow. The information on the proximal extrahepatic bile duct embryonal development, variant anatomy, innervation, arterial, venous and lymphatic supply is too general and not detailed. The present review brought together and systemized exiting to the date data on anatomy and function of this biliary tract portion. Unique, different from the majority of hollow organs organization of the proximal extrahepatic bile duct adapts them to the flow of the bile, i.e. viscous aggressive due to pH about 8.0 and detergents fluid, under higher wall pressure than in other parts of biliary tree.

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Biliary-Colonic Fistula: A Case Report and Literature Review

The American Surgeon ◽

10.1177/000313480607200415 ◽

2006 ◽

Vol 72 (4) ◽

pp. 347-350 ◽

Cited By ~ 2

Author(s):

Gitonga Munene ◽

Jay A. Graham ◽

Richard W. Holt ◽

Lynt B. Johnson ◽

Harry P. Marshall

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Surgical Repair ◽

Open Cholecystectomy ◽

Hepatic Flexure ◽

Unusual Complication ◽

Extensive Experience ◽

Colonic Fistula ◽

The Right

We report the occurrence of common bile duct obstruction and biliary-colonic fistula after open cholecystectomy. Although it is a very unusual complication after cholecystectomy, biliary-colonic fistula should be part of the differential diagnosis for patients presenting with sepsis after open or laparoscopic cholecystectomy. After confirmation and characterization of the injury by endoscopic retrograde cholangiopancreatography and cholangiogram, assessment for undrained collections by computed tomography scan, control of sepsis and coagulopathy, and nutritional support, surgical repair was undertaken. The patient underwent fistula take-down between the common bile duct and the colon at the hepatic flexure, primary closure of the colon enterotomy, and a Roux-en-Y end-to-side hepaticojejunostomy at the confluence of the right and left hepatic ducts. Recovery was uneventful and the patient was doing well at the 6-month follow-up. Surgical repair should be undertaken by surgeons with extensive experience in hepatobiliary reconstruction.

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Right Hepatic Artery: A Cadaver Investigation and Its Clinical Significance

Anatomy Research International ◽

10.1155/2015/412595 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Usha Dandekar ◽

Kundankumar Dandekar ◽

Sushama Chavan

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Hepatic Artery ◽

Hepatic Duct ◽

Common Hepatic Duct ◽

Normal Anatomy ◽

Surgical Safety ◽

Right Hepatic Artery ◽

The Common ◽

The Right

The right hepatic artery is an end artery and contributes sole arterial supply to right lobe of the liver. Misinterpretation of normal anatomy and anatomical variations of the right hepatic artery contribute to the major intraoperative mishaps and complications in hepatobiliary surgery. The frequency of inadvertent or iatrogenic hepatobiliary vascular injury rises with the event of an aberrant anatomy. This descriptive study was carried out to document the normal anatomy and different variations of right hepatic artery to contribute to existing knowledge of right hepatic artery to improve surgical safety. This study conducted on 60 cadavers revealed aberrant replaced right hepatic artery in 18.3% and aberrant accessory right hepatic artery in 3.4%. Considering the course, the right hepatic artery ran outside Calot’s triangle in 5% of cases and caterpillar hump right hepatic artery was seen in 13.3% of cases. The right hepatic artery (normal and aberrant) crossed anteriorly to the common hepatic duct in 8.3% and posteriorly to it in 71.6%. It has posterior relations with the common bile duct in 16.7% while in 3.4% it did not cross the common hepatic duct or common bile duct. The knowledge of such anomalies is important since their awareness will decrease morbidity and help to keep away from a number of surgical complications.

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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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Metastatic Neoplasms of the Large Bile Ducts- A Clinicopathological Study

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqab191.119 ◽

2021 ◽

Vol 156 (Supplement_1) ◽

pp. S58-S58

Author(s):

A Verma ◽

I Nalbantoglu ◽

A Barbieri

Keyword(s):

Gastrointestinal Tract ◽

Bile Duct ◽

Hepatic Duct ◽

Biliary Tree ◽

Primary Site ◽

Primary Adenocarcinoma ◽

Common Hepatic Duct ◽

Biliary Strictures ◽

Left Hepatic Duct ◽

Treatment Considerations

Abstract Introduction/Objective Biliary strictures are often considered malignant until proven otherwise. While the majority of malignant biliary strictures represent a primary neoplasm, secondary involvement by metastasis also rarely occurs. Primary cholangiocarcinoma and metastatic disease have different treatment considerations and likely different prognoses. The aim of this study is to look at the clinico-pathological characteristics of metastatic neoplasms of the bile duct. Methods/Case Report We retrospectively searched the pathology archives for biliary biopsies between 1991-2020. Patients with primary biliary, gallbladder, pancreatic, ampullary and hepatic malignancies and all cases of lymphoma were excluded from the study. A total of 20 cases were included. Results (if a Case Study enter NA) The median age of the patients was 63 years with a M:F ratio of 1.9:1. The biopsies were taken from the common bile duct (n=17), common hepatic duct (n=2) and left hepatic duct (n=1). 8 patients had synchronous and 12 had metachronous presentation. The overall median interval between the bile duct metastasis and primary was 18 months (Range: 0-100 months) for all patients and 33 months for metachronous cases. For 13 tumors, the primary site of origin was in the gastrointestinal tract (colon: 7; stomach: 4; anal canal: 1; gastro-esophageal junction: 1). Other primary sites included breast (3 cases), lung, endometrium and adrenal (1 each). One case presented with metastatic melanoma with an occult primary. Adenocarcinoma was the most common histological subtype seen in 17 cases. Other histological subtypes were squamous cell carcinoma, adrenocortical carcinoma and melanoma. Conclusion Secondary involvement of the bile duct by metastasis is rare. Most cases are metastasis from the lumenal gastrointestinal tract, with colon being the most common primary site. They are more likely to have a metachronous presentation with rare instances of bile duct metastasis as the first presentation. Awareness of secondary involvement of the biliary tree by metastasis is important as they can have prognostic and therapeutic significance.

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The segment IV approach: a useful method for achieving the critical view of safety during laparoscopic cholecystectomy in patients with anomalous bile duct

BMC Surgery ◽

10.1186/s12893-020-00873-x ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Shuichi Fujioka ◽

Keigo Nakashima ◽

Hiroaki Kitamura ◽

Yuki Takano ◽

Takeyuki Misawa ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Hepatic Duct ◽

Left Hepatic Duct ◽

Critical View ◽

Critical View Of Safety ◽

Right Border ◽

Imaginary Line ◽

Branching Point ◽

The Right

Abstract Background The critical view of safety (CVS) method can be achieved by avoiding vasculo-biliary injury resulting from misidentification during laparoscopic cholecystectomy (LC). Although achieving the CVS has become popular worldwide, there is no established standardized technique to achieve the CVS in patients with an anomalous bile duct (ABD). We recently reported our original approach for securing the CVS using a new landmark, the diagonal line of the segment IV of the liver (D-line). The D-line is an imaginary line that lies on the right border of the hilar plate. The cystic structure can be securely isolated along the D-line without any misidentification, regardless of the existence of an ABD. We named this approach the segment IV approach in LC. Methods In this study, we adopted the segment IV approach in patients with an ABD. Results From October 2015 to June 2020, 209 patients underwent LC using the segment IV approach. Among them, three (1.4%) were preoperatively diagnosed with an ABD. The branching point of the cystic duct was the posterior sectional duct, anterior sectional duct, or left hepatic duct in each patient. The CVS was achieved in all cases without any complications. Conclusion It is a promising technique, especially even for patients with an ABD during LC.

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Aberrant Right Hepatic Duct Originating from the Right Posterior Duct with Low Insertion into the Common Bile Duct

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2006.04.007 ◽

2006 ◽

Vol 203 (6) ◽

pp. 972 ◽

Cited By ~ 1

Author(s):

Gonzalo Pérez ◽

Ricardo O. Escárcega ◽

Julio Gargantua ◽

Salvador Fuentes-Alexandro

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Hepatic Duct ◽

The Common ◽

The Right

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CONDUCTO BILIAR SUBVESICULAR: HALLAZGO QUIRÚRGICO Y COLANGIOGRÁFICO. Sub-gallbladder bile duct: Surgical and colangiographic findings

Revista Argentina de Anatomía Clínica ◽

10.31051/1852.8023.v8.n1.14210 ◽

2016 ◽

Vol 8 (1) ◽

pp. 50-54

Author(s):

Alejandro M Russo ◽

Pablo M Sciuto

Keyword(s):

Bile Duct ◽

Biliary Tract ◽

Hepatic Duct ◽

Gallbladder Bile ◽

Deep Knowledge ◽

The Right

Las variaciones de la vía biliar son frecuentes y pueden provocar complicaciones en el curso de una colecistectomía. Por esta razón el cirujano debe estar interiorizado en la anatomía habitual así como en las posibles variantes. Presentamos un caso de un conducto biliar subvesicular encontrando durante una colecistectomía. Se trató de un conducto que se originaba en el conducto hepático derecho y terminaba en la vesícula biliar. Se procedió a la ligadura del mismo y su posterior sección. El paciente tuvo una buena evolución y fue dado de alta a las 48 horas del posoperatorio. En vistas a este hallazgo se discuten la anatomía y las implicancias quirúrgicas de esta variante. Variations in the biliary tract are frequent and may cause complications during a cholecyst-ectomy. Thus, the surgeon must have a deep knowledge of the usual configuration of the biliary tract as well as its variations. We report a case of a subvesical bile duct found during a cholec-ystectomy. It consisted of a bile duct which originated from the right hepatic duct and ended in the gallbladder. The duct was clipped and cut, the patient had good evolution and was discharged 48 hours after surgery. The anatomy and surgical implications of this variation are discussed.

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