Biliary ductal variations and its clinical implications: a cadaveric study

Priyanka Parmar, Suresh Kanta Rathee, SK Dhattarwal, Sanjay Marwah


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.


Accessory, Biliary, Hepatic

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Moore KL, Persaud TVN. The Developing Human; clinically oriented embryology. 8th ed. New Delhi; Elsevier; 2008:220.

Bismuth H, Nakche R, Dimond T. Management Strategies in Resection for Hilar Cholangiocarcinoma. Annals Surg. 1992;215(1):312.

Moosman DA. The Surgical significance of six anomalies of biliary ductal system. J Surg Gynecol Obstet. 1970;131(4):655-60.

Abeysuriya V, Salgado S, Deen KI, Kumarage SK. Hepatic cystic duct and a rare extra-hepatic cruciate- arterial anastomosis; a case report. J Med Case Rep. 2008;2:37.

Sadler TW. Langman’s medical embryology. 8th ed. Philaldelphia: Lippincott Williams and Wilkins; 2000:283-285.

Aristotle S, Felicia C, Sakthivelavan S. An unusual variation of extrahepatic biliary ductal system; Hepatic cystic duct. JCDR. 2011;5(5):984-5.

Losanoff JE, Kjossev KT, Katrov E. Hepatic cystic duct-a case report. J Surg Radiol Anat. 1996;18:339-41.

Adkins RB, Chapman WC, Reddy VS. Embryology, Anatomy and Surgical applications of the extrahepatic biliary system. Surg Clin N Am. 2000;80:363-79.

Talpur KA, Laghari AA, Yousfani SA, Malik AM, Memon AI, Khan SA. Anatomical variations and congenital anomalies of extra hepatic biliary system encountered during laparoscopic cholecystectomy. JPMA. 2010;60(2):89-93.

Flint ER. Abnormalities of right hepatic, cystic and gastroduodenal arteries and of the bile ducts. Br J Surg. 1923;10:509-19.

Lichtenstein M, Nicosia AJ. The clinical significance of accessory hepato biliary ducts. Ann Surg. 1955;141(1):120-4.

Johnston EV, Anson BJ. Variations in the formation and vascular relationships of the bile ducts. J Surg Gynecol Obstet. 1952;94(6):669-86.

Uchiyama K, Tani M, Kawai M, Ueno M, Hama T, Yamaue H. Preoperative evaluation of the extrahepatic bile duct structure for laparoscopic cholecystectomy. Surg Endos. 2006;20(7):1119-23.

Shobha devi T, Hari Krishna P. The study of variations of extra hepatic biliary apparatus. JDMS. 2013;5(5):25-31.

Taourel P, Bret PM, Reinhold C, Barkun AN, Atri M. Anatomical variants of biliary tree: diagnosis with MR cholangiopancreatography. J Radiol. 1996;199(2):521-7.

Rajguru J, Khare S, Jain S, Ghai R, Singla M, Goel P. Variations in the external morphology of Gall Bladder. J Anat Soc Ind. 2012;61(1):9-12.

Delic J, Savkovic A, Isakovic E. Aberrant and accessory bile ducts. Med Art. 2005;59(5):288-9.

Izuishi K, Toyama Y, Nakano S, Goda F, Usuki H, Masaki T, et al. Preoperative assessment of the aberrant bile duct using multislice computed tomography cholangiography. Am J Surg. 2005;189(1):53-5.

Dundaraddy RY, Mahesh GM. Study of variations in the Extrahepatic biliary system. BMJ. 2012;3(03):8-10.

Mariolis-Sapsakos T, Kalles V, Papatheodorou K, Goutas N, Papapanagiotou I, Flessas I, et al. Anatomic variations of the right hepatic duct: results and surgical implications from a cadaveric study. Anat Res Int. 2012;2012:838179.

Dohke M, Watanabe Y, Okumura A, Amoh Y, Oda K, Ishimori T, et al. Anomalies and anatomic variants of the biliary tree revealed by MR cholangiopancreatography. Am J Roentgenol. 1999;173(5):1251-4.

Mortelem KJ, Ros PR. Anatomic variants of the biliary tree: MR cholangiographic findings and clinical applications. Am J Roentgenol. 2001;177:389-94.

Talpur KA, Laghari AA, Yousfani SA, Malik AM, Memon AI, Khan SA. Anatomical variations and congenital anomalies of Extra hepatic biliary system encountered during laparoscopic cholecystectomy. J Pak Med Assoc. 2010;60(2):89-93.

Nigam GL, Lalwani R, Ramesh Babu CS, Chauhan K. Surgical Anatomy of sub-hepatic biliary system. J Anat Soc Ind. 2014;63(1):48-51.

Bernard P, Le Borgne J, Dupas B, Kohnen-Shari N, Raoult S, Hamel A. Double common bile duct with ectopic drainage into stomach. J Surg Radiol Anat. 2001;23(4):269-72.

Lamah M, Dickson GH. Congenital anatomical abnormalities of the Extrahepatic biliary duct. J Surg Radiol Anat. 1999;21:325-7.

Yamashita K, Oka Y, Urakami A, Iwamoto S, Tsunoda T, Eto T. Double common bile duct. A case report and review of the Japanese literature. J Surg. 2002;131(6):676-81.

Onder H, Ozdemir MS, Tekbas G, Ekici F, Gumus H, Bilci A. 3-T MRI of the biliary tract variations. Surg Radiol Anat. 2013;35(2):161-7.

Tsitouridis I, Lazaraki G, Papastergiou C, Pagalos E, Germanidis G. Low conjunction of the cystic duct with the common bile duct: does it correlate with the formation of common bile duct. Surg Endos. 2007;21(1):48-52.