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Anatomic variation in intrahepatic bile ducts: an analysis of intraoperative cholangiograms in 300 consecutive donors for living donor liver transplantation.

Choi JW, Kim TK, Kim KW, Kim AY, Kim PN, Ha HK, Lee MG - Korean J Radiol (2003 Apr-Jun)

Bottom Line: Anatomical variation in IHDs was classified according to the branching pattern of the right anterior and right posterior segmental duct (RASD and RPSD, respectively), and the presence or absence of the first-order branch of the left hepatic duct (LHD), and of an accessory hepatic duct.The anatomy of the intrahepatic bile ducts was typical in 63% of cases (n=188), showed triple confluence in 10% (n=29), anomalous drainage of the RPSD into the LHD in 11% (n=34), anomalous drainage of the RPSD into the common hepatic duct (CHD) in 6% (n=19), anomalous drainage of the RPSD into the cystic duct in 2% (n=6), drainage of the right hepatic duct (RHD) into the cystic duct (n=1), the presence of an accessory duct leading to the CHD or RHD in 5% (n=16), individual drainage of the LHD into the RHD or CHD in 1% (n=4), and unclassified or complex variation in 1% (n=3).The two most common variations were drainage of the RPSD into the LHD (11%) and triple confluence of the RASD, RPSD and LHD (10%).

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea.

ABSTRACT

Objective: To describe the anatomical variation occurring in intrahepatic bile ducts (IHDs) in terms of their branching patterns, and to determine the frequency of each variation.

Materials and methods: The study group consisted of 300 consecutive donors for liver transplantation who underwent intraoperative cholangiography. Anatomical variation in IHDs was classified according to the branching pattern of the right anterior and right posterior segmental duct (RASD and RPSD, respectively), and the presence or absence of the first-order branch of the left hepatic duct (LHD), and of an accessory hepatic duct.

Results: The anatomy of the intrahepatic bile ducts was typical in 63% of cases (n=188), showed triple confluence in 10% (n=29), anomalous drainage of the RPSD into the LHD in 11% (n=34), anomalous drainage of the RPSD into the common hepatic duct (CHD) in 6% (n=19), anomalous drainage of the RPSD into the cystic duct in 2% (n=6), drainage of the right hepatic duct (RHD) into the cystic duct (n=1), the presence of an accessory duct leading to the CHD or RHD in 5% (n=16), individual drainage of the LHD into the RHD or CHD in 1% (n=4), and unclassified or complex variation in 1% (n=3).

Conclusion: The branching pattern of IHDs was atypical in 37% of cases. The two most common variations were drainage of the RPSD into the LHD (11%) and triple confluence of the RASD, RPSD and LHD (10%).

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Schematic drawing of IHD anatomy. Type 1 is typical. Type 2 involves triple confluence, the simultaneous emptying of the RASD, RPSD and LHD into the CHD. In type 3, the RPSD drains anomalously, and in type 4, the RHD drains into the cystic duct. In type 5, an accessory duct is present, and in type 6, segments II and III drain individually into the RHD or CHD. Type 7 shows unclassified or complex variation.R=right hepatic duct, L=left hepatic duct, RA=right anterior segmental duct, RP=right posterior segmental duct, C=cystic duct, Acc=accessory duct
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Figure 1: Schematic drawing of IHD anatomy. Type 1 is typical. Type 2 involves triple confluence, the simultaneous emptying of the RASD, RPSD and LHD into the CHD. In type 3, the RPSD drains anomalously, and in type 4, the RHD drains into the cystic duct. In type 5, an accessory duct is present, and in type 6, segments II and III drain individually into the RHD or CHD. Type 7 shows unclassified or complex variation.R=right hepatic duct, L=left hepatic duct, RA=right anterior segmental duct, RP=right posterior segmental duct, C=cystic duct, Acc=accessory duct

Mentions: The branching patterns of IHDs were classified as one of seven types (Fig. 1). The anatomy of type 1 is typical, i.e. a common hepatic duct is formed by fusion of the RHD and LHD (Fig. 2). The RHD arises through fusion of the RASD, which drains anterior segments V and VIII, and the RPSD, which drains posterior segments VI and VII. Type 2 involves triple confluence, the simultaneous emptying of the RASD, RPSD and LHD into the common hepatic duct (CHD) (Fig. 3). Type 3, representing anomalous drainage of the RPSD, is subdivided into types 3A, 3B, and 3C, according to the drainage pattern of the RPSD. In type 3A, this drains into the LHD (Fig. 4a); in type 3B, into the CHD (Fig. 4b); and in type 3C, into the cystic duct. Type-4 IHD systems are those in which the RHD drains into the cystic duct (Fig. 5). Type 5, in which an accessory duct is present, is subdivided into types 5A and 5b according to the drainage pattern of duct: in type 5A, it drains into the CHD (Fig. 6a), and in type 5B, into the RHD (Fig. 6b). A type 6 is one in which segments II and III of the segmental duct drain individually into the RHD or CHD (Fig. 7), while a type 7 shows unclassified or complex variation (Fig. 8).


Anatomic variation in intrahepatic bile ducts: an analysis of intraoperative cholangiograms in 300 consecutive donors for living donor liver transplantation.

Choi JW, Kim TK, Kim KW, Kim AY, Kim PN, Ha HK, Lee MG - Korean J Radiol (2003 Apr-Jun)

Schematic drawing of IHD anatomy. Type 1 is typical. Type 2 involves triple confluence, the simultaneous emptying of the RASD, RPSD and LHD into the CHD. In type 3, the RPSD drains anomalously, and in type 4, the RHD drains into the cystic duct. In type 5, an accessory duct is present, and in type 6, segments II and III drain individually into the RHD or CHD. Type 7 shows unclassified or complex variation.R=right hepatic duct, L=left hepatic duct, RA=right anterior segmental duct, RP=right posterior segmental duct, C=cystic duct, Acc=accessory duct
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2698075&req=5

Figure 1: Schematic drawing of IHD anatomy. Type 1 is typical. Type 2 involves triple confluence, the simultaneous emptying of the RASD, RPSD and LHD into the CHD. In type 3, the RPSD drains anomalously, and in type 4, the RHD drains into the cystic duct. In type 5, an accessory duct is present, and in type 6, segments II and III drain individually into the RHD or CHD. Type 7 shows unclassified or complex variation.R=right hepatic duct, L=left hepatic duct, RA=right anterior segmental duct, RP=right posterior segmental duct, C=cystic duct, Acc=accessory duct
Mentions: The branching patterns of IHDs were classified as one of seven types (Fig. 1). The anatomy of type 1 is typical, i.e. a common hepatic duct is formed by fusion of the RHD and LHD (Fig. 2). The RHD arises through fusion of the RASD, which drains anterior segments V and VIII, and the RPSD, which drains posterior segments VI and VII. Type 2 involves triple confluence, the simultaneous emptying of the RASD, RPSD and LHD into the common hepatic duct (CHD) (Fig. 3). Type 3, representing anomalous drainage of the RPSD, is subdivided into types 3A, 3B, and 3C, according to the drainage pattern of the RPSD. In type 3A, this drains into the LHD (Fig. 4a); in type 3B, into the CHD (Fig. 4b); and in type 3C, into the cystic duct. Type-4 IHD systems are those in which the RHD drains into the cystic duct (Fig. 5). Type 5, in which an accessory duct is present, is subdivided into types 5A and 5b according to the drainage pattern of duct: in type 5A, it drains into the CHD (Fig. 6a), and in type 5B, into the RHD (Fig. 6b). A type 6 is one in which segments II and III of the segmental duct drain individually into the RHD or CHD (Fig. 7), while a type 7 shows unclassified or complex variation (Fig. 8).

Bottom Line: Anatomical variation in IHDs was classified according to the branching pattern of the right anterior and right posterior segmental duct (RASD and RPSD, respectively), and the presence or absence of the first-order branch of the left hepatic duct (LHD), and of an accessory hepatic duct.The anatomy of the intrahepatic bile ducts was typical in 63% of cases (n=188), showed triple confluence in 10% (n=29), anomalous drainage of the RPSD into the LHD in 11% (n=34), anomalous drainage of the RPSD into the common hepatic duct (CHD) in 6% (n=19), anomalous drainage of the RPSD into the cystic duct in 2% (n=6), drainage of the right hepatic duct (RHD) into the cystic duct (n=1), the presence of an accessory duct leading to the CHD or RHD in 5% (n=16), individual drainage of the LHD into the RHD or CHD in 1% (n=4), and unclassified or complex variation in 1% (n=3).The two most common variations were drainage of the RPSD into the LHD (11%) and triple confluence of the RASD, RPSD and LHD (10%).

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea.

ABSTRACT

Objective: To describe the anatomical variation occurring in intrahepatic bile ducts (IHDs) in terms of their branching patterns, and to determine the frequency of each variation.

Materials and methods: The study group consisted of 300 consecutive donors for liver transplantation who underwent intraoperative cholangiography. Anatomical variation in IHDs was classified according to the branching pattern of the right anterior and right posterior segmental duct (RASD and RPSD, respectively), and the presence or absence of the first-order branch of the left hepatic duct (LHD), and of an accessory hepatic duct.

Results: The anatomy of the intrahepatic bile ducts was typical in 63% of cases (n=188), showed triple confluence in 10% (n=29), anomalous drainage of the RPSD into the LHD in 11% (n=34), anomalous drainage of the RPSD into the common hepatic duct (CHD) in 6% (n=19), anomalous drainage of the RPSD into the cystic duct in 2% (n=6), drainage of the right hepatic duct (RHD) into the cystic duct (n=1), the presence of an accessory duct leading to the CHD or RHD in 5% (n=16), individual drainage of the LHD into the RHD or CHD in 1% (n=4), and unclassified or complex variation in 1% (n=3).

Conclusion: The branching pattern of IHDs was atypical in 37% of cases. The two most common variations were drainage of the RPSD into the LHD (11%) and triple confluence of the RASD, RPSD and LHD (10%).

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Related in: MedlinePlus