scholarly journals Anatomic Variations of the Right Hepatic Duct: Results and Surgical Implications From a Cadaveric Study

2019 ◽  
Vol 17 (01) ◽  
pp. 90-93
Author(s):  
Akinchan Kafle ◽  
Bidur Adhikari ◽  
Rajani Shrestha ◽  
Nirju Ranjit
Keyword(s):  
Hepatic Duct ◽  
Clinical Importance ◽  
Left Lobe ◽  
Common Hepatic Duct ◽  
Blue Dye ◽  
Left Hepatic Duct ◽  
Cross Sectional ◽  
Bile Duct Wall ◽  
Split Liver ◽  
The Right

Background: Right hepatic duct, formed by the confluence of the anterior and posterior right sectorial ducts, joins left hepatic duct to form common hepatic duct. This fashion of confluence does not prevail in all cases. The sectorial ducts can aberrantly meet left duct and rest of the ducts from the left lobe of liver. Presence of such variation imposes clinical importance during peri-hilar, split liver transplant surgery or cholecystectomy. Nepalese population has not been explored before disregarding clinical necessity as MRI or cholangiography. Methods: Descriptive cross sectional study was conducted in 107 cases dissecting the main portal fissure separating hemi liver and extrahepatic biliary confluences. Methylene blue dye was injected and bile duct wall was cut open to the study pattern of the confluence. Data analysis was done with Statistical Package for Social Sciences (SPSS) version 17.Results: Normal variant of confluence was found in 72% cases, aberrant right posterior sectorial duct joins left hepatic duct in 9.3% and aberrant right anterior duct or low insertion of the right posterior sectorial duct was found in 1.9%. 9.3% of cases there is no true right hepatic duct often described as triple confluence. 0.9% cases showed no particular pattern of confluence where common hepatic duct is formed by multiple confluence. Quadrate lobe was found to be draining into right anterior sectorial duct in a single case.Conclusions: Right hepatic duct confluence pattern is variable and all the evidence occurs at the main portal fissure. Right sectorial duct may join the left duct avoiding normal confluence pattern. Right posterior sectorial duct may be inserted low in the common bile duct.Keywords: Duct; hepatic; sectorial; variation.

scholarly journals Anatomic Variations of the Right Hepatic Duct: Results and Surgical Implications from a Cadaveric Study

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Theodoros Mariolis-Sapsakos ◽  
Vasileios Kalles ◽  
Konstantinos Papatheodorou ◽  
Nikolaos Goutas ◽  
Ioannis Papapanagiotou ◽  
...  
Keyword(s):  
Bile Ducts ◽  
Hepatic Duct ◽  
Anatomical Variations ◽  
Common Hepatic Duct ◽  
Drainage Pattern ◽  
Left Hepatic Duct ◽  
Surgical Interventions ◽  
Drainage Patterns ◽  
The Common ◽  
The Right

Purpose. Thorough understanding of biliary anatomy is required when performing surgical interventions in the hepatobiliary system. This study describes the anatomical variations of right bile ducts in terms of branching and drainage patterns, and determines their frequency. Methods. We studied 73 samples of cadaveric material, focusing on the relationship of the right anterior and posterior segmental branches, the way they form the right hepatic duct, and the main variations of their drainage pattern. Results. The anatomy of the right hepatic duct was typical in 65.75% of samples. Ectopic drainage of the right anterior duct into the common hepatic duct was found in 15.07% and triple confluence in 9.59%. Ectopic drainage of the right posterior duct into the common hepatic duct was discovered in 2.74% and ectopic drainage of the right posterior duct into the left hepatic duct in 4.11%. Ectopic drainage of the right anterior duct into the left hepatic ductal system and ectopic drainage of the right posterior duct into the cystic duct was found in 1.37%. Conclusion. The branching pattern of the right hepatic duct was atypical in 34.25% of cases. Thus, knowledge of the anatomical variations of the extrahepatic bile ducts is important in many surgical cases.

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

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.

scholarly journals Anomalous anatomical variation in extrahepatic biliary tree and pancreas and its related vessels: a cadaveric study

2019 ◽  
Vol 6 (9) ◽  
pp. 3111
Author(s):  
Mahim Koshariya ◽  
Sheikh Behram ◽  
Jay Prakash Singour ◽  
Shashikant Tiwari ◽  
Vidhu Khare
Keyword(s):  
Cystic Duct ◽  
Hepatic Duct ◽  
Anatomical Variation ◽  
Clinical Importance ◽  
Biliary Tree ◽  
Cystic Artery ◽  
Common Hepatic Duct ◽  
Left Hepatic Duct ◽  
Extrahepatic Biliary Tree ◽  
Insight Into

Background: Congenital anamolies of extrahepatic biliary apparatus and pancreas have long been recognized and are of clinical importance because when present may surprise the surgeon during surgery and lead to iatrogenic injuries. Surgeries on extra-hepatic biliary apparatus and pancreas are regularly performed throughout the world. Thus insight into the normal anatomy and congenital variations will reduce complication and definitely improve outcome.Methods: Study was conducted in department of surgery GMC Bhopal and dissection was carried out in Department of Forensic Medicine on 100 cadavers with approval from ethical committee.Results: In 100 cases 70 were male and 30 female. The most common variation in extra hepatic biliary apparatus was short cystic duct was found in 6% cases then formation of common hepatic duct by union of right hepatic duct and left hepatic duct was intrahepatic in 3% cases. There was low insertion of cystic duct with common hepatic duct in 1% case. Cystic artery originating from left hepatic artery in 1% case, in 1% case cystic artery was anterior to common hepatic duct. In Pancreas anterior arterial arcade was absent in 2% cases and its origin varied in 2% case. Posterior pancreatic arcade absent in 1% cases and variation in origin was present in 1% case. The variation in pancreatic duct course was present in 22% cases.Conclusions: Thus significant variation was seen and it could definitely be helpful to hepatobiliary, laproscopic surgeons, radiologist and will further contribute to literature on variation of extrahepatic biliary apparatus and pancreas and its related vessels.

scholarly journals Severe case of post cholecystectomy vasculobiliary injury successfully treated by right hepatectomy with a jump graft to the remaining left hepatic lobe

2020 ◽  
Vol 2020 (9) ◽  
Author(s):  
Carlo Marino ◽  
Ignacio Obaid ◽  
Gabriela Ochoa ◽  
Nicolás Jarufe ◽  
Jorge A Martínez ◽  
...  
Keyword(s):  
Hepatic Duct ◽  
Open Cholecystectomy ◽  
Severe Case ◽  
Common Hepatic Duct ◽  
Right Hepatectomy ◽  
Left Hepatic Lobe ◽  
Left Hepatic Duct ◽  
Hepatic Lobe ◽  
The Right ◽  
Vasculobiliary Injury

Abstract Vasculobiliary injuries (VBI) caused by cholecystectomies are infrequent but extremely serious. We report a case of a severe VBI successfully treated at our center. A 22-year-old woman underwent an open cholecystectomy as treatment for acute cholecystitis and bile duct stones. She was transferred to our center on postoperative Day 4 because of progressive jaundice and encephalopathy. After a proper investigation, we found an extreme VBI with infarction of the right hepatic lobe associated with complete interruption of the portal vein and proper hepatic artery flows and full section of the common hepatic duct. Right hepatectomy with portal—Rex shunt revascularization of the left hepatic lobe and Roux-en-Y hepaticojejunostomy to the left hepatic duct was done. The patient was discharged on the 60th postoperative day. Discussion: This case shows the successful surgical treatment of a severe cholecystectomy’s VBI, avoiding an emergency liver transplant.

scholarly journals A Rare Case of Intraductal Papillary Mucinous Neoplasm of the Biliary Duct in a Patient with Prostate Adenocarcinoma

2016 ◽  
Vol 10 (3) ◽  
pp. 743-748
Author(s):  
Ravish Parekh ◽  
Gregory Krol ◽  
Cyrus Piraka ◽  
Surinder Batra
Keyword(s):  
Soft Tissue ◽  
Intraductal Papillary Mucinous Neoplasm ◽  
Hepatic Duct ◽  
Prostate Adenocarcinoma ◽  
Common Hepatic Duct ◽  
Left Hepatic Duct ◽  
Ductal System ◽  
Mucinous Neoplasm ◽  
The Common ◽  
The Right

Intraductal papillary mucinous neoplasms (IPMNs) are mucin-producing papillary neoplasms of the pancreatic or biliary ductal system that exhibit variable cellular atypia and cause ductal dilation. There are few reported cases of IPMN arising from the biliary tree in the literature. It has a higher propensity to undergo malignant transformation compared to IPMN arising from the pancreatic duct. An 80-year-old male underwent cross-sectional tomography (CT) imaging of the abdomen for evaluation of prostate adenocarcinoma, which revealed an incidental 2.3 × 2.7 cm soft tissue mass centered at the porta hepatis with diffuse dilatation of the left intrahepatic biliary ductal system and mild prominence of the right intrahepatic ductal system. Endoscopic ultrasound showed 2 adjacent hilar masses involving the common hepatic duct and the left hepatic duct with protrusion of the tissue into the lumen of the duct and upstream ductal dilatation. Endoscopic retrograde cholangiopancreatography revealed a large filling defect in the common hepatic duct extending into the left hepatic duct. A large amount of clot and soft tissue with a fish-egg appearance was retrieved. The patient underwent left hepatic lobectomy, radical resection of the common hepatic duct with Roux-en-Y hepaticojejunostomy to the right hepatic duct. Histopathological examination of the resected specimen revealed intraductal papillary mucinous neoplasm with diffuse high-grade dysplasia. Follow-up CT scan of the abdomen 2 months after the surgery was negative for any masses.

EXPERIENCE OF EVALUATION OF PATIENTS OF OBSTRUCTIVE JAUNDICE BY SONOGRAPHY AND MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY AT A TERTIARY CARE CENTRE IN EASTERN INDIA

2021 ◽  
pp. 61-64
Author(s):  
Santosh Kumar Prasad ◽  
Nupur Nupur ◽  
Akshit Pathak ◽  
Indra Shekhar Thakur ◽  
Vijay Shankar Prasad
Keyword(s):  
Magnetic Resonance ◽  
Obstructive Jaundice ◽  
Hepatic Duct ◽  
Tertiary Care ◽  
Pancreatic Head ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Stricture Formation ◽  
Tertiary Care Centre ◽  
Left Hepatic Duct ◽  
Cross Sectional

INTRODUCTION: Jaundice means yellow due to the yellowish discolouration of skin, sclera, and mucous membrane seen in jaundice caused by bilirubin pigment. It is divided in to two forms obstructive(surgical) and non- obstructive (non-surgical). AIM AND OBJECTIVE: To evaluate patients of obstructive jaundice by sonography and magnetic resonance cholangiopancreatography and compare the reporting and ndings by both the modalities. MATERIALS AND METHODS: Cross sectional observational study done from November 2018 to October 2020 and consists of 32 patients who had clinical jaundice and consented to being subjected to both ultrasound and MRCP. OBSERVATIONS:Both USG and MRCP were able to detect extrahepatic CBD dilatation equally in 25 patients. In 5(15.6%) patients USG and MRI both demonstrated intrahepatic mass causing obstruction at the level of conuence of right and left hepatic duct or CHD. Ultrasonography was able to detect the intrinsic mass of the extrahepatic common bile duct in 2(6.2%) patients out of 32 patients in our study population. MRCP could detect the same in 6(18.7%) patients. In our study narrowing of CBD with stricture formation and upstream dilatation of biliary tree was identied in 10(31.2%) patients on MRCP. Ultrasound could diagnose the same in one patient. Both USG and MRCP were able to detect pancreatic head mass as well as pseudocyst. CONCLUSION: The accuracy of MRCP was found to be comparable to that of ERCP for diagnosis of etiology for obstructive jaundice. MRCP allows better lesion characterization and assessment. However, the patchy availability of MR machines become the main achilles heel for the surgeons as well as the radiologists. Hence the valuable role of the omnipresent ultrasonography become immense.

scholarly journals Quantitative Assessment Of The Variations In Thyroid Dimensions In Relation To Increase In Serum TSH In Euthyroids

2018 ◽  
Vol 08 (02) ◽  
pp. 72-76
Author(s):  
Mahrukh Kamran ◽  
Sahar Mubeen ◽  
Iffat Raza ◽  
Sanobar Bughio ◽  
Hira Waseem ◽  
...  
Keyword(s):  
Total Variation ◽  
Cross Sectional Study ◽  
Thyroid Stimulating Hormone ◽  
Left Lobe ◽  
University Hospital ◽  
P Value ◽  
Cross Sectional ◽  
Right Lobe ◽  
The Right ◽  
Serum Tsh

Objectives: To determine the effect of serum TSH on thyroid dimensions of each lobe and to measure the amount of effect of per unit increase in serum TSH on thyroid dimensions of each lobe in euthyroids. Study Design: It was a cross-sectional study. Setting: The study was conducted at Ziauddin University Hospital, Clifton, Karachi. Methodology: Healthy participants aged 21 years and above were included through convenient sampling. Serum Thyroid stimulating hormone was evaluated and ultrasound of thyroid gland TG of 192 euthyroid participants was performed. Spearman correlation and regression analysis was applied to evaluate the relationship between TSH and TG dimensions Results: Relationship of increase in serum TSH with decrease in light lobe AP dimension was most significant. (r= -0.142 P-Value=0.001) and CC dimension least significant (r= -0.0098 P-Value=0.001). Where as in the left lobe AP dimension decreases significantly with increase serum TSH (r= -0.147 P-value=0.001). 11.7% of total variation in AP dimension, 3.5% of total variation in ML dimension and 6.5% of total variation in CC dimension in right lobe thyroid are because of serum TSH. While 9.5% of the total variation in AP dimension in left lobe is also due to serum TSH. Conclusion: Negative and significant correlation between serum TSH and thyroid dimensions was observed. Serum TSH inversely and significantly affects all the dimensions of the right lobe and only one dimension in the left lobe

scholarly journals When It Doesn't Fit: Congenital Anomalies of the Choledochus

2020 ◽  
Vol 08 (01) ◽  
pp. e86-e89
Author(s):  
Helena Reusens ◽  
Mark Davenport
Keyword(s):  
Case Report ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Extrahepatic Bile Duct ◽  
Hepatic Duct ◽  
Common Hepatic Duct ◽  
Resected Specimen ◽  
Cystic Dilatation ◽  
Left Hepatic Duct ◽  
Distal Common Bile Duct

Abstract Introduction Congenital choledochal malformations (CCMs) are characterized by intra- and/or extrahepatic bile duct dilatation. Five basic types (1–5) are recognized in Todani's classification and its modifications, of which types 1 and 4 typically have an associated anomalous pancreatobiliary junction and common channel (CC). We describe two cases with previously undescribed features. Case Report 1 Antenatal detection of a cyst at porta hepatis was made in an otherwise normal girl of Iranian parentage. She was confirmed to be a CCM (20 mm diameter), postnatally, with no evidence of obstruction. Surgical exploration was performed at 12 weeks. She had an isolated cystic dilatation of the right-hepatic duct only. The left-hepatic duct and common bile duct (CBD) were normal without a CC. Histology of the resected specimen showed stratified squamous epithelium. Case Report 2 A preterm (31 weeks of gestation) boy of Nigerian parentage was presented. His mother was HIV + ve and he was treated with nucleoside reverse transcriptase inhibitors following birth. He had persistent cholestatic jaundice and a dilated (10 mm) bile duct from birth. Although the jaundice resolved, the dilatation persisted and increased, coming to surgery aged 2.5 years. This showed cystic dilatation confined to the common hepatic duct, and otherwise normal distal common bile duct and no CC. Result Both underwent resection with the Roux-en-Y hepaticojejunostomy reconstruction to the transected right-hepatic duct alone in case 1, leaving the preserved left duct and CBD in continuity, and to the transected common hepatic duct in case 2. Conclusions Neither choledochal anomaly fitted into the usual choledochal classification and case 1 appears unique in the literature.

scholarly journals Morphometry of Acromion Process of Human Scapulae and Its Clinical Importance Amongst Nepalese Population

2013 ◽  
Vol 10 (2) ◽  
pp. 33-36 ◽  
Author(s):  
DI Mansur ◽  
K Khanal ◽  
MK Haque ◽  
K Sharma
Keyword(s):  
Shoulder Joint ◽  
Surgical Repair ◽  
Average Length ◽  
Clinical Importance ◽  
Medical Sciences ◽  
Cross Sectional ◽  
Bipedal Gait ◽  
Measuring Tape ◽  
The Right

Background Morphometry of the acromion process of the scapula is an important factor implicated in impingement syndrome of the shoulder joint. Authors who have studied this process have tried to classify it according to the standard Bigliani classification viz., type 1, 2 and 3. Objectives To analyze and classify the acromion process of human scapulae. Methods The present study was observational, cross-sectional and descriptive in nature. The present study was conducted on 68 adult human scapulae (30 right and 38 left) of unknown age and sex in the Department of Anatomy, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal. The length and breadth of the acromion process and the distances from the tip of the acromion process to the uppermost point of the glenoid cavity and to the tip of the corocoid process were measured with a help of caliper and measuring tape. Results The average length of acromion process on the right and left scapulae were 46.46 ± 5SD mm and 45.57 ± 5.21 SD mm respectively. The average breadth of acromion process of right and left scapulae were 26.63 ± 3.55 SD mm and 27.23 ± 3.06 SD mm respectively. The acromio-coracoid distance on the right and left side were 39.03 + 6.20 mm and 39.39 +5.32 mm respectively. The acromio-glenoid distance was also measured which was 31.83 +3.66 mm & 31.97 +3.96 mm on right and left side respectively. The acromion process was classified in the present study into 3 types, based on the shape as: Triangular - 36.76%, Quadrangular - 52.94% and Tubular - 10.29%. Conclusions Knowing the data on the shape and various distances of acromion may not only help the orthopaedicians during surgical repair around the shoulder joint but also may be of interest to the anthropologists when studying about the evolution of the bipedal gait. The morphometric analysis of the acromion should be used like an auxiliary to promote a better knowledge about the disease that appears in this area. Kathmandu University Medical Journal | Vol.10 | No. 2 | Issue 38 | Apr – June 2012 | Page 33-36 DOI: http://dx.doi.org/10.3126/kumj.v10i2.7340

scholarly journals Right Hepatic Artery: A Cadaver Investigation and Its Clinical Significance

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
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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