DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20181294

Anatomical variations in the extra hepatic biliary system: a cross sectional study

P. G. Anandhi, V. N. Alagavenkatesan

Abstract


Background: The anatomy of the biliary system has been the subject of extended research for many years. Largely because of their surgical importance in cholecystectomies and the ease with which they may be studied. Though, interest has been focused on the extrahepatic bile ducts very few studies have been carried out in the Indian subcontinent. Objectives was to study the anatomical variations in extrahepatic biliary system in sample of Indian cadaveric specimens.

Methods: The study material consisted of 20 adult dissection room cadavers and 30 enbloc post-mortem specimens. Cadaver specimens were studied from dissection room. Post-mortem enbloc specimens were collected from the Department of Forensic Medicine, Madurai Medical College, Madurai. They were studied by conventional dissection method.

Results: The key abnormalities found in all bladder were Hartman's pouch shape and neck in 2 (4%) subjects each. Gallstones were present in 2 (4%) subject. The length of the common Bile duct was ranging from as short as 6.5 cm in 24% of the subjects to 9cm in 4% of the subjects. High level of the cystic duct union with the common hepatic duct was noted in16% of specimens and in remaining 2% it was low union. Abnormal arrangement of structures in hepatoduodenal duct was normal in 98% but was abnormal in 2% of subjects. A total of 14% of the specimens had accessory ducts. Double and accessory cystic artery was found in 2% of the subjects each.  In 8% of the subjects, cystic artery had abnormal course and division. The right hepatic artery was had shown abnormal course and division in 4% of the subjects. Abnormal boundaries of Calot’s triangle was found in 2% of the subjects. Abnormal contents of Calot’s triangle include Accessory hepatic ducts in 10% of subjects.

Conclusions: Anatomical variations of the extrahepatic biliary system are very common and a through an understanding of them is essential for surgeons to avoid damage to vital structures during surgical procedures and better surgical outcomes.


Keywords


Anatomy, Extrahepatic biliary system

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References


De Filippo M CM, Quinto S, Rastelli A, Bertellini A, Martora R, et al. Congenital anomalies and variations of the bile and pancreatic ducts: magnetic resonance cholangiopancreatography findings, epidemiology and clinical significance. Radiol Med. 2008;113(6):841-59.

Cachoeira E RA, Gabrielli C. Anatomic Variations of Extrahepatic Bile Duct and Evaluation of the Length of Ducts Composing the Cystohepatic Triangle. Int J Morphol. 2012;30(1):279-83.

Lamah M, Dickson GH. Congenital anatomical abnormalities of the extrahepatic biliary duct: a personal audit. Surg Radiol Anat. 1999;21(5):325-7.

Dundaraddy MG. Study of Variations in the Extrahepatic Biliary System. Biomirror J. 2012;3(3):1-3.

Hribernik MG, EM, Mlakar B, Ravnik, D. Variations of intrahepatic and proximal extrahepatic bile ducts. Hepatogastroenterology. 2003;50(50):342-8.

MG B. Variations in the extrahepatic biliary tract. Arch Surgery. 1929;19:321-6.

McGregor AL. A synopsis of surgical anatomy. Brownstown, MI: William and Wilkins;1963.

Bismuth H. Surgical anatomy and anatomical surgery of the liver. World J surgery. 1982;6(1):3-9.

Castaing D. Surgical anatomy of the biliary tract. HPB (Oxford). 2008;10(2):72-6.

Blumgart's WJ. Surgery of the Liver, Biliary Tract and Pancreas. 5th Edi. Philadelphia: WB. Saunders;2012.

Northover JMA TJ. A new look at the arterial supply of the bile duct of man and its surgical implications. Br J Surg. 1979;66:379.

Kanno N, LeSage G, Glaser S, Alvaro D, Alpini G. Functional heterogeneity of the intrahepatic biliary epithelium. Hepatology. 2000;31(3):555-61.

Ress AM, Sarr MG, Nagorney DM, Farnell MB, Donohue JH, McIlrath DC. Spectrum and management of major complications of laparoscopic cholecystectomy. American J Surg. 1993;165(6):655-62.

DL N. The biliary system. Sabiston DC Text Book of Surgery. 13 Ed. Igaku-Shoin: W.B. Saunders company;1986:1128-36.

Suhocki PV. Injury to aberrant bile ducts during cholecystectomy: a common cause of diagnosed error and treatment delay. Am J Roentgenol. 1999;72:955-59.

Leena AB. Study of Hartmann’s pouch in south keralites. journal of evolution of medical and dental sciences-JEMDS. 2015;4(26):4491-5.

van Eijck FC, van Veen RN, Kleinrensink GJ, Lange JF. Hartmann's gallbladder pouch revisited 60 years later. Surg Endo. 2007;21(7):1122-5.

Blidaru PC, Crivii C, Seceleanu A. The common bile duct: size, course, relations. Romanian J Morphology Embryology. 2010;51(1):141-4.

Devi KP. The Study of Variations of Extra Hepatic Biliary Apparatus. IOSR-JDMS. 2013;5(5):25-31.

Khayat MF, Al-Amoodi MS, Aldaqal SM, Sibiany A. Abnormal Anatomical Variations of Extra-Hepatic Biliary Tract, and Their Relation to Biliary Tract Injuries and Stones Formation. Gastroenterology Res. 2014;7(1):12-6.

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. Anatomy research international. 2012;2012.

Dandekar DK. Cystic Artery: Morphological Study and Surgical Significance. Anatomy Res Inter. 2016;2016:7201858.

Talpur LA, 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.