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Le KL, Tran MQ, Pham PC, Trinh MT, Pham TN. Optimizing Laparoscopic Cholecystectomy in Aberrant Biliary Anatomy: A Case of Cystic Duct Insertion Into the Right Posterior Hepatic Duct. Cureus 2025; 17:e81483. [PMID: 40308389 PMCID: PMC12042712 DOI: 10.7759/cureus.81483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2025] [Indexed: 03/31/2025] Open
Abstract
Anatomic variations of the biliary tree, particularly those involving the cystic duct, pose significant challenges during laparoscopic cholecystectomy and can lead to inadvertent bile duct injury (BDI) if unrecognized. We report a rare variant in which the cystic duct inserts into the right posterior hepatic duct, which itself drains directly into the common bile duct - an aberrant configuration not frequently described in the literature. A 65-year-old man with grade I acute cholecystitis underwent preoperative imaging with computed tomography and magnetic resonance cholangiopancreatography, revealing the unusual biliary anatomy. A laparoscopic cholecystectomy was performed using the critical view of safety (CVS) approach, followed by intraoperative cholangiography (IOC) via gallbladder puncture to delineate the anatomy, ensuring accurate identification of the cystic duct and artery. The procedure was completed safely without complications. This case highlights the importance of preoperative imaging, adherence to CVS, and IOC in achieving safe outcomes in the setting of complex biliary anatomy. Despite increasing interest in indocyanine green (ICG) fluorescence cholangiography, its availability remains limited in some centers; thus, conventional techniques remain valuable. We advocate for a multimodal approach to mitigate the risk of BDI in patients with atypical biliary configurations.
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Affiliation(s)
- Kim-Long Le
- Hepato-Pancreato-Biliary Surgery Department, Nhan dan Gia Dinh Hospital, Ho Chi Minh, VNM
- Surgery Department, Pham Ngoc Thach University of Medicine, Ho Chi Minh, VNM
| | - Minh-Quang Tran
- Hepato-Pancreato-Biliary Surgery Department, Nhan dan Gia Dinh Hospital, Ho Chi Minh, VNM
- Surgery Department, Pham Ngoc Thach University of Medicine, Ho Chi Minh, VNM
| | - Phu-Cuong Pham
- Hepato-Pancreato-Biliary Surgery Department, Nhan dan Gia Dinh Hospital, Ho Chi Minh, VNM
- Surgery Department, Pham Ngoc Thach University of Medicine, Ho Chi Minh, VNM
| | - My-Tran Trinh
- Surgery Department, Pham Ngoc Thach University of Medicine, Ho Chi Minh, VNM
- Hepato-Pancreato-Biliary Surgery Department, Nhan dan Gia Dinh Hospital, Ho Chi Minh, VNM
| | - Tri-Nhan Pham
- Surgery Department, Pham Ngoc Thach University of Medicine, Ho Chi Minh, VNM
- Hepato-Pancreato-Biliary Surgery Department, Nhan dan Gia Dinh Hospital, Ho Chi Minh, VNM
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Garg S, Dutta U, Chaluvashetty SB, Kumar KH, Kalra N, Sahni D, Aggarwal A. The anatomy of the cystic duct and its association with cholelithiasis: MR Cholangiopancreatographic study. Clin Anat 2022; 35:847-854. [PMID: 35316537 DOI: 10.1002/ca.23856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/17/2022] [Accepted: 03/11/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The aims of this article are to detail the anatomy of the cystic duct in patients with and without gallstones as it relates to maneuvering of the duct during endoscopic transpapillary gallbladder cannulation, and to elucidate its role in the dynamics of bile flow during gallbladder contraction. MATERIAL AND METHODS One hundred MRCPs were retrieved from the prospectively maintained radiology data system to assess the configuration of the cystic duct and its confluence vis-a-vis the main biliary duct. RESULTS The configuration of the cystic duct was broadly classified into four types: Angular (44%), Linear (40%), Spiral (11%) and Complex (5%). The level of emergence of the cystic duct from the bile duct was proximal in 29%, middle in 49% and distal in 20%. Its direction from the bile duct was to the right and angled upward in 69%, right and angled downward in 15%, left and angled upward in 13%, and left and angled downward in 1%. Its orifice was on the lateral surface of the bile duct in 50%, posterior in 19%, anterior in 15% and medial in 14%. In two cases, the cystic duct opened directly into the duodenum. Tortuous cystic ducts and non-lateral unions with the bile duct were significantly more prevalent in gallstone cases than the non-gallstone group (p=0.02). CONCLUSIONS The present study details the spatial anatomy of the cystic duct vis a vis the main biliary duct. This has not been well investigated to date but has become increasingly relevant with the advent of recent gallbladder interventions.
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Affiliation(s)
- Shallu Garg
- Department of Anatomy, St. John's Medical College affiliated to RGUHS, Bengaluru, India
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sreedhara B Chaluvashetty
- Department of Radio diagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - K Hemanth Kumar
- Department of Gastrointestinal Surgery, Manipal hospital, Bengaluru, India
| | - Naveen Kalra
- Department of Radio diagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Daisy Sahni
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anjali Aggarwal
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Taghavi A, Azizi M, Rasekhi A, Gholami Z. Anatomic Variations of the Cystic Duct in Magnetic Resonance Cholangiopancreatography in Shiraz: A Cross-Sectional Study. IRANIAN JOURNAL OF MEDICAL SCIENCES 2022; 47:48-52. [PMID: 35017777 PMCID: PMC8743372 DOI: 10.30476/ijms.2021.88447.1918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/23/2021] [Accepted: 03/13/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Anatomic variations of the cystic duct (CD) are commonly encountered. Being aware of these variants will reduce complications subsequent to surgical, endoscopic, or percutaneous procedures. Magnetic resonance cholangiopancreatography (MRCP) is the least invasive and the most reliable modality for biliary anatomy surveys. This study aimed to determine the prevalence of cystic duct variations in the Iranian population. METHODS In this retrospective cross-sectional study, MRCP images of 350 patients referred to Shiraz Faraparto Medical Imaging and Interventional Radiology Center from October 2017 to October 2018 were reviewed. The CD course and insertion site to the extrahepatic bile duct (EHBD) was determined and documented in 290 cases. Descriptive statistics and Chi square test were applied for data analysis via SPSS software. RESULTS About 77% of cases revealed the classic right lateral insertion to the middle third of EHBD. The insertion of CD to the upper third and the right hepatic duct was 10%, and the insertion to the medial aspect of the middle third of EHBD from anterior or posterior was noted to be about 7.6%. From 2.8% of insertions to the lower third, 1% demonstrated parallel course, and finally, 0.3% of cases presented short CD. CONCLUSION CD variations are relatively common, and MRCP mapping prior to the hepatobiliary interventions could prevent unexpected consequences.
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Affiliation(s)
- Alireza Taghavi
- Gastroenterohepatology Research Center (GRC), Department of Gastroenterology and Hepatology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoud Azizi
- Gastroenterohepatology Research Center (GRC), Department of Gastroenterology and Hepatology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Rasekhi
- Medical Imaging Research Center (MIRC), Department of Radiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zeinab Gholami
- Medical Imaging Research Center (MIRC), Department of Radiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Gündüz N, Doğan MB, Alacagöz M, Yağbasan M, Orhan Söylemez UP, Atalay B. Anatomical variations of cystic duct insertion and their relationship with choledocholithiasis: an MRCP study. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00579-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The frequency of insertion variations of cystic duct (CD) is inconsistent between studies caused to some extent by the way they give the relative frequency of the variations. Moreover, certain insertion variations have been reported to be associated with choledocholithiasis. This study aimed to assess the frequency of CD insertion variations with a comprehensive way of classification in an unselected population in whom MRCP was performed. Moreover, the relationship between the types of variant insertions and choledocholithiasis using MRCP was also assessed. Patients undergoing magnetic resonance cholangiopancreatography (MRCP) were reviewed retrospectively by two radiologists who were blinded to the clinical data. The normal insertion was defined as the union through middle one third of the lateral border of the extrahepatic bile duct. The transverse site (lateral, medial, anterior, and posterior) and the craniocaudal level (high, mid and low) of insertions and their intersections were assessed using axial and coronal slices, respectively. In addition, the frequencies of the CD insertion variations were compared between choledocholithiasis and control (no-choledocholithiasis) groups.
Results
A total of 307 patients (124 with choledocholithiasis and 183 controls) were analyzed. A true variant insertion was found in 149 (48.5%) cases. The insertion variations were less frequent in the choledocholithiasis group [50 (40.3%) vs. 99 (54.1%), respectively, p = 0.018]. The frequencies of craniocaudal level of insertion differed significantly between groups (p = 0.014) that was driven by a lower rate of low medial insertion (1.6% vs. 9.8%, respectively) in the choledocholithiasis group. The frequencies of transverse site of insertion were similar between groups (p = 0.314). The low medial insertion was 80.7% less likely associated with choledocholithiasis even after adjustment for age (Odds ratio: 0.193, 95% Confidence interval: 0.039–0.954, p = 0.044). The interreader agreement for insertion assessment was good (Cohen’s Kappa: 0.748, p < 0.001).
Conclusions
The prevalence of CD insertion variations in an unselected population undergoing MRCP is quite high and a mid-posterior insertion is the most common variant type. Insertion variations of CD, the low medial insertion in particular, are less common in patients with choledocholithiasis than controls.
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Three-dimensional visualization technique compared with magnetic resonance cholangiopancreatography for evaluation of anatomic variants of pediatric congenital choledochal cysts. Pediatr Surg Int 2021; 37:705-713. [PMID: 33507374 DOI: 10.1007/s00383-020-04854-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to compare the application of a three-dimensional (3D) visualization technique and magnetic resonance cholangiopancreatography (MRCP) for diagnosis of pediatric congenital choledochal cysts. METHODS Thin slices of coronal heavily T2-weighted pulse sequences of MRI pertaining to 35 patients were retrospectively used to reconstruct 3D models. Diagnoses and variants of the biliary system were evaluated based on the 3D models and MRCP imaging. The quality of delineation of the biliary duct system and the Todani classification were evaluated. Wilcoxon and Chi-squared tests were used for statistical analysis. RESULTS Two cases that were diagnosed as type II congenital choledochal cysts using the 3D model were diagnosed as type I using MRCP imaging. Significant differences were observed between the two modalities with respect to the delineation of the right anterior bile duct, right posterior bile duct, and left hepatic duct. The excellent and good rates obtained with the 3D model (65.7%) were much better than that obtained with MRCP (37.1%) imaging. Two cases with accessory hepatic ducts (5.7%), one case with an accessory pancreatic duct (2.8%), and two cases with biliary strictures at the hepatic hilum (5.7%) were detected using the 3D models. In contrast, only one case with an accessory hepatic duct and one case with a biliary stricture at the hepatic hilum were detected using MRCP. CONCLUSION The 3D visualization technique facilitated more precise morphological evaluation of congenital choledochal cysts and provided comprehensive spatial anatomic information for diagnosis.
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Ojo AS, Pollard A. Risk of Gallstone Formation in Aberrant Extrahepatic Biliary Tract Anatomy: A Review of Literature. Cureus 2020; 12:e10009. [PMID: 32864277 PMCID: PMC7449616 DOI: 10.7759/cureus.10009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The age-long mnemonic of '5Fs' (fat, female, fertile, forty, and fair) has traditionally been used in medical school instructions to describe the risk factors for gallstone disease. However, evidence suggests that aberrant extrahepatic biliary tract (EHBT) anatomy may contribute significantly to the risk of gallstone disease. This review explores the anatomy and embryological bases of EHBT variations as well as the prevalence of these variations. Also, we discuss the risk factors for gallstone formation in the relationship between gallstone disease and aberrant EHBT anatomy.
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Kurahashi S, Komatsu S, Matsumura T, Fukami Y, Arikawa T, Saito T, Osawa T, Uchino T, Kato S, Suzuki K, Toda Y, Kaneko K, Sano T. A novel classification of aberrant right hepatic ducts ensures a critical view of safety in laparoscopic cholecystectomy. Surg Endosc 2020; 34:2904-2910. [PMID: 32377838 DOI: 10.1007/s00464-020-07610-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 04/28/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Based on the spatial relationship of an aberrant right hepatic duct (ARHD) with the cystic duct and gallbladder neck, we propose a practical classification to evaluate the specific form predisposing to injury in laparoscopic cholecystectomy (LC). METHODS We retrospectively investigated the preoperative images (mostly magnetic resonance cholangiopancreatography) and clinical outcomes of 721 consecutive patients who underwent LC at our institute from 2015 to 2018. We defined the high-risk ARHD as follows: Type A: communicating with the cystic duct and Type B: running along the gallbladder neck or adjacent to the infundibulum (the minimal distance from the ARHD < 5 mm), regardless of the confluence pattern in the biliary tree. Other ARHDs were considered to be of low risk. RESULTS A high-risk ARHD was identified in 16 cases (2.2%): four (0.6%) with Type A anatomy and 12 (1.7%) with Type B. The remaining ARHD cases (n = 34, 4.7%) were categorized as low risk. There were no significant differences in the operative outcomes (operative time, blood loss, hospital stay) between the high- and low- risk groups. Subtotal cholecystectomy was applied in four cases (25%) in the high-risk group, a significantly higher percentage than the low-risk group (n = 1, 2.9%). In all patients with high-risk ARHD, LC was completed safely without bile duct injury or conversion to laparotomy. CONCLUSIONS Our simple classification of high-risk ARHD can highlight the variants located close to the dissecting site to achieve a critical view of safety and may contribute to avoiding inadvertent damage of an ARHD in LC.
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Affiliation(s)
- Shintaro Kurahashi
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Shunichiro Komatsu
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
| | - Tatsuki Matsumura
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Yasuyuki Fukami
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Takashi Arikawa
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Takuya Saito
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Takaaki Osawa
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Tairin Uchino
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Shoko Kato
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Kenta Suzuki
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Yoko Toda
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Kenitiro Kaneko
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Tsuyoshi Sano
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
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Magnetic resonance and retrograde endoscopic cholangiopancreatography-based identification of biliary tree variants: are there type-related variabilities among the Saudi population? Surg Radiol Anat 2019; 41:869-877. [DOI: 10.1007/s00276-019-02249-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 04/25/2019] [Indexed: 12/17/2022]
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Rodrigues G, Pandit SR, Khan A, Veerabharappa B, Jayasankar B, Anaparti R. High insertion of cystic duct at the gallbladder fundus: An undescribed anomaly! J Minim Access Surg 2018; 15:256-258. [PMID: 30416140 PMCID: PMC6561060 DOI: 10.4103/jmas.jmas_199_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The anatomy of the biliary tree is complex, and its variations of both intra- and extra-hepatic bile ducts can be found in approximately 30% of the general population. These variations are not picked up on routine pre-operative investigations of patients planned for a laparoscopic cholecystectomy (LC) and often present as an unusual ‘surprise’ and a challenge that can make dissection in the Calot's triangle difficult leading to iatrogenic injury. We present a case of a 53-year-old female with an undescribed anomaly encountered during an LC. There was a high insertion of the cystic duct into the fundus of the gallbladder. No such anomaly has been described in literature till date.
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Affiliation(s)
- Gabriel Rodrigues
- Department of General Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shruti Rahul Pandit
- Department of General Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Afroz Khan
- Department of General Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Bharath Veerabharappa
- Department of General Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Balaji Jayasankar
- Department of General Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Rasagna Anaparti
- Department of General Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Kostakis ID, Feretis T, Stamopoulos P, Garoufalia Z, Dimitroulis D, Kykalos S, Kouraklis G, Tsourouflis G. A rare anatomical variation of the biliary tree. J Surg Case Rep 2017; 2017:rjx087. [PMID: 28584622 PMCID: PMC5451662 DOI: 10.1093/jscr/rjx087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 03/19/2017] [Accepted: 05/05/2017] [Indexed: 12/13/2022] Open
Abstract
A 31-year-old woman was admitted to our department in order to undergo a laparoscopic cholecystectomy. The operation was converted to open due to cholorrhea during the dissection in the hepatocystic triangle. The cholorrhea came from a transected bile duct, which was 2 mm in diameter, came out of the hepatoduodenal ligament, ran along the common hepatic duct and drained into the cystic duct, in proximity to the neck of the gallbladder. The gallbladder was removed and an intraoperative cholangiography revealed that the aberrant bile duct was originated from the right posterior sectoral duct (RPSD). The RPSD continued its typical course up to its confluence with the right anterior sectoral duct and the formation of the right hepatic duct. This is a rare type of aberrant bile duct, which is added to the long catalogue of the anatomical variations of the biliary tree.
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Affiliation(s)
- Ioannis D Kostakis
- Second Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Medical School, 'Laiko' General Hospital, Athens, Greece
| | - Themistoklis Feretis
- Second Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Medical School, 'Laiko' General Hospital, Athens, Greece
| | - Paraskevas Stamopoulos
- Second Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Medical School, 'Laiko' General Hospital, Athens, Greece
| | - Zoe Garoufalia
- Second Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Medical School, 'Laiko' General Hospital, Athens, Greece
| | - Dimitrios Dimitroulis
- Second Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Medical School, 'Laiko' General Hospital, Athens, Greece
| | - Stylianos Kykalos
- Second Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Medical School, 'Laiko' General Hospital, Athens, Greece
| | - Gregory Kouraklis
- Second Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Medical School, 'Laiko' General Hospital, Athens, Greece
| | - Gerasimos Tsourouflis
- Second Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Medical School, 'Laiko' General Hospital, Athens, Greece
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Handra-Luca A, Ngo A, Hong SM. Perivesical cystic duct of the gallbladder. Surg Radiol Anat 2017; 39:1401-1403. [PMID: 28493009 DOI: 10.1007/s00276-017-1869-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 05/04/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Adriana Handra-Luca
- Service d'Anatomie Pathologique, APHP GHU Avicenne, Universite Paris Nord Sorbonne Cite, 125 rue Stalingrad, 93009, Bobigny, France.
- Université Paris Nord Sorbonne Cite, UFR SMBH Bobigny, Bobigny, France.
| | - Antoine Ngo
- Centre de Radiologie, Villeneuve St Georges, France
| | - Seung-Mo Hong
- Department of Pathology, Asan Medical Center, Seoul, South Korea
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Adibelli Z, Adatepe M, Isayeva L, Esen O, Yildirim M. Pancreas divisum: A risk factor for pancreaticobiliary tumors – an analysis of 1628 MR cholangiography examinations. Diagn Interv Imaging 2017; 98:141-147. [DOI: 10.1016/j.diii.2016.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/07/2016] [Accepted: 08/07/2016] [Indexed: 02/07/2023]
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Adibelli ZH, Adatepe M, Imamoglu C, Esen OS, Erkan N, Yildirim M. Anatomic variations of the pancreatic duct and their relevance with the Cambridge classification system: MRCP findings of 1158 consecutive patients. Radiol Oncol 2016; 50:370-377. [PMID: 27904444 PMCID: PMC5120578 DOI: 10.1515/raon-2016-0041] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 06/06/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The study was conducted to evaluate the frequencies of the anatomic variations and the gender distributions of these variations of the pancreatic duct and their relevance with the Cambridge classification system as morphological sign of chronic pancreatitis using magnetic resonance cholangiopancreatography (MRCP). PATIENTS AND METHODS We retrospectively reviewed 1312 consecutive patients who referred to our department for MRCP between January 2013 and August 2015. We excluded 154 patients from the study because of less than optimal results due to imaging limitations or a history of surgery on pancreas. Finally a total of 1158 patients were included in the study. RESULTS Among the 1158 patients included in the study, 54 (4.6%) patients showed pancreas divisum, 13 patients (1.2%) were defined as ansa pancreatica. When we evaluated the course of the pancreatic duct, we found the prevalence 62.5% for descending, 30% for sigmoid, 5.5% for vertical and 2% for loop. The most commonly observed pancreatic duct configuration was Type 3 in 528 patients (45.6%) where 521 patients (45%) had Type 1 configuration. CONCLUSIONS Vertical course (p = 0.004) and Type 2 (p = 0.03) configuration of pancreatic duct were more frequent in females than males. There were no statistically significant differences between the gender for the other pancreatic duct variations such as pancreas divisium, ansa pancreatica and course types other than vertical course (p > 0.05 for all). Variants of pancreas divisum and normal pancreatic duct variants were not associated with morphologic findings of chronic pancreatitis by using the Cambridge classification system. The ansa pancreatica is a rare type of anatomical variation of the pancreatic duct, which might be considered as a predisposing factor to the onset of idiopathic pancreatitis.
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Affiliation(s)
| | - Mustafa Adatepe
- Department of Radiology, Urfa Balõklõgol State Hospital, Urfa, Turkey
| | - Cetin Imamoglu
- Department of Radiology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Ozgur Sipahi Esen
- Department of Radiology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Nazif Erkan
- Department of Surgery, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Mehmet Yildirim
- Department of Surgery, Bozyaka Training and Research Hospital, Izmir, Turkey
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Anatomical Variations of Cystic Ducts in Magnetic Resonance Cholangiopancreatography and Clinical Implications. Radiol Res Pract 2016; 2016:3021484. [PMID: 27313891 PMCID: PMC4897729 DOI: 10.1155/2016/3021484] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 03/24/2016] [Indexed: 02/07/2023] Open
Abstract
Background. Anatomical variations of cystic duct (CD) are frequently unrecognized. It is important to be aware of these variations prior to any surgical, percutaneous, or endoscopic intervention procedures. Objectives. The purpose of our study was to demonstrate the imaging features of CD and its variants using magnetic resonance cholangiopancreatography (MRCP) and document their prevalence in our population. Materials and Methods. This study included 198 patients who underwent MRCP due to different indications. Images were evaluated in picture archiving communication system (PACS) and variations of CD were documented. Results. Normal lateral insertion of CD at middle third of common hepatic duct was seen in 51% of cases. Medial insertion was seen in 16% of cases, of which 4% were low medial insertions. Low insertion of CD was noted in 9% of cases. Parallel course of CD was present in 7.5% of cases. High insertion was noted in 6% and short CD in 1% of cases. In 1 case, CD was draining into right hepatic duct. Congenital cystic dilation of CD was noted in one case with evidence of type IV choledochal cyst. Conclusion. Cystic duct variations are common and MRCP is an optimal imaging modality for demonstration of cystic duct anatomy.
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Anatomic Variations of Biliary Ducts: Magnetic Resonance Cholangiopancreatography Findings of 1041 Consecutive Patients. Eur Surg 2016. [DOI: 10.1007/s10353-016-0393-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Park JS, Lee DH, Lim JH, Jeong S, Jeon YS. Morphologic factors of biliary trees are associated with gallstone-related biliary events. World J Gastroenterol 2015; 21:276-282. [PMID: 25574102 PMCID: PMC4284346 DOI: 10.3748/wjg.v21.i1.276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 06/07/2014] [Accepted: 07/16/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the risk factors for gallstone-related biliary events.
METHODS: This retrospective cohort study evaluated magnetic resonance cholangiopancreatography images from 141 symptomatic and 39 asymptomatic gallstone patients who presented at a single tertiary hospital between January 2005 and December 2012.
RESULTS: Logistic regression analysis showed significant differences between symptomatic and asymptomatic patients with gallstones in relation to the number of gallstones, the angle between the long axis of the gallbladder and the cystic duct, and the cystic duct diameter. Multivariate analysis showed that the number of gallstones (OR = 1.27, 95%CI: 1.03-1.57; P = 0.026), the angle between the long axis of the gallbladder and the cystic duct (OR = 1.02, 95%CI: 1.00-1.03; P = 0.015), and the diameter of the cystic duct (OR = 0.819, 95%CI: 0.69-0.97; P = 0.018) were significantly associated with biliary events. The incidence of biliary events was significantly elevated in patients who had the presence of more than two gallstones, an angle of > 92° between the gallbladder and the cystic duct, and a cystic duct diameter < 6 mm.
CONCLUSION: These findings will help guide the treatment of patients with asymptomatic gallstones. Clinicians should closely monitor patients with asymptomatic gallstones who exhibit these characteristics.
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Kokudo T, Uldry E, Halkic N. An uncommon cause of right hepatic duct stenosis. Gastroenterology 2013; 145:1208, 1502. [PMID: 24409487 DOI: 10.1053/j.gastro.2013.08.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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