Morphological expression of the extrahepatic bile duct. A study in a sample of Colombian mestizo population

  • Bladimir Saldarriaga Tellez Teacher
  • Edgar Giovanni Corzo Gomez Facultad de Salud, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
  • Pedro Luis Forero Porras Universidad Industrial de Santander, Bucaramanga, Colombia, Instituto de Medicina Legal, Regional Nororiente, Bucaramanga, Colombia
  • Luis Ernesto Ballesteros Acuña Universidad Industrial de Santander, Bucaramanga, Colombia; Facultad de Salud, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia

Abstract

 


Background: The great variability of the extrahepatic bile duct (EBD) has clinical-surgical implications. The objective of this study was to characterize the morphological expressions of EBD.


Methods and findings


This descriptive study, done by injecting a semi-synthetic (Palatal GP40L 85%; styrene 15%) impregnated with mineral green dye into the gallbladder, to determine the anatomical characteristics and the biometrics of EBD in 33 blocks formed from the supra-mesocolic floor.The gallbladder presented a length of 66.9 ± 1.7 mm. The Hartmann´s Pouch was observed in 16 specimens (50%). The lengths of the cystic duct (CD), common hepatic duct (CHD) and common bile duct (choledoch duct) were 27.8 ± 1.6 mm, 28.6 ± 11.39 mm and 60.6 ± 11.6 mm respectively.


The presence of accessory hepatic ducts (AHD) was found in three samples (9.1%). In 29 specimens  (87.9%) the cystic duct  presented medium length, while in 4 cases (12.1%) the CD was long (P < 0, 05). The trajectory of the lateral oblique of CD was present in 23 cases (69.7%), with statistically significant differences in relation to the other trajectories of the CD (P <0, 05). In 18 samples (55%) the cystic-hepatic union appeared at the level of the middle third of the EBD, while in 15 (45%) cases the union of the CD was low (P<0,05).


Conclusions


The mathematical distribution of the segments of the EBD, carried out in this study, provides reliability to the assessment of the cystic-hepatic junction level. The presence of CHA and the level of the cysto-hepatic junction are important anatomical references, especially in emergency room procedures.

References

1. AbeshaAmbaye M, Anderson BA, and Tsegay A. Variation of Cystic Duct Insertion in Relation to the Extrahepatic Ducts and Observed Frequency of Double Lumen Apparent Common Bile Duct. International Journal of Pharma Sciences and Research (IJPSR), 2015; Feb; 6(2): 254-8. Available from: https://pdfs.semanticscholar.org/ea3c/d4d450c5ec17f79f7c7724079892a532d842.pdf
2. ALVES, EM, FONSECA, EF. Estudo Anatomotopográfico das vias biliares extra-hepáticas e do trígono cisto-hepático post mortem: enfoque cirúrgico. Revista Perquirere, 2015; dec, 12 (2): 187-200. Available from: http://perquirere.unipam.edu.br/documents/23700/1025842/Estudo++anatomotopogr%C3%A1fico+das+vias+biliares+extra-hep%C3%A1ticas+e++do++tr%C3%ADgono+cistohep%C3%A1tico+post+mortem-+enfoque+cir%C3%BArgico.pdf
3. Awazli, LG. Anatomical Variations of Extrahepatic Biliary System. Iraqi Journal of Medical Sciences. 2013 11(3): 258-264. Available from: https://www.iasj.net/iasj?func=fulltext&aId=80326
4. BERCI, George. Biliary ductal anatomy and anomalies: the role of intraoperative cholangiography during laparoscopic cholecystectomy. Surgical Clinics of North America. 1992; 72(5). 1069-1075. Available from: https://www.sciencedirect.com/journal/surgical-clinics-of-north-america/vol/72/issue/5
5. Cachoeira, E, Rivas A, Gabrielli C. "Anatomic variations of extrahepatic bile ducts and evaluation of the length of ducts composing the cystohepatic triangle." Int. j. morphol. 2012; 30(1): 279-283. Available from: https://pdfs.semanticscholar.org/87ea/764f7139cacbd5bed02b631a256214796901.pdf
6. Cavalcanti JS, Oliveira EL, Santos LP, Godoi ET, Oliveira CL, Lins AP Estudo anatomotopográfico das vias biliares extra hepáticas e do trígono cistohepático. Acta Cir. Bras. 2002 Feb; 17(1): 30-35. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-86502002000100005&lng=pt&tlng=pt
7. Catalano, O A, Singh AH, Uppot RN, Hahn PF, Ferrone CR, Sahani DV. Vascular and biliary variants in the liver: implications for liver surgery. Radiographics. 2008; 28(2): 359-378. Available from: https://pubs.rsna.org/doi/pdf/10.1148/rg.282075099
8. Choi JW, Kim TK, Kim KW. Kim PN, Ha HK, Lee MG. Anatomic variation in intrahepatic bile ducts: an analysis of intraoperative cholangiograms in 300 consecutive donors for living donor liver transplantation. Korean journal of radiology. 2003; 4(2): 85-90. Available from. https://synapse.koreamed.org/DOIx.php?id=10.3348/kjr.2003.4.2.85&vmode=FULL
9. Chun, K. Recent classifications of the common bile duct injury. Korean journal of hepato-biliary-pancreatic surgery. 2014; 18 (3): 69-72.Available from: https://www.synapse.koreamed.org/search.php?where=aview&id=10.14701/kjhbps.2014.18.3.69&code=0110KJHBPS&vmode=FULL
10. de Méndez, TR, Pérez M. Variaciones anatómicas del conducto cístico. MedULA. Revista de la Facultad de Medicina. 1998; 7 (1) : 12-18. Available from. https://dialnet.unirioja.es/servlet/articulo?codigo=6454708
11. Devi, T, Krishna P. The Study of Variations of Extra Hepatic Biliary Apparatus. IOSR-JDMS. 2013; 5(5): 25-31. Available from: http://www.iosrjournals.org/
12. Getsov, P, and Borislav V. "Anatomical Variations Of Confluence Of Cystic Duct In Bulgarian Population: Diagnostic Opportunities Of Magnetic Resonance Imaging." International Journal Of Medical Science And Clinical Inventions. 2016; 3(5): 1856-61. Available from: http://valleyinternational.net/index.php/our-jou/ijmsci
13. Khan, AS, Paracha SA, Shah Z, Thair M, Wahav K. Anatomical variations of cystic duct encountered during open cholecystectomy. Khyber Medical University Journal. 2012; 4 (1): 19-22. Available from: http://www.kmuj.kmu.edu.pk/article/view/8614

14. Khayat, MF, Al-Amoodi MS, Aldakal SM, Sibiany A. Abnormal anatomical variations of extra-hepatic biliary tract, and their relation to biliary tract injuries and stones formation. Gastroenterology research. 2014; 7(1): 12-16. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5051136/
15. Lamah M, Karanjia ND, Dickson GH. Anatomical variations of the extrahepatic biliary tree: Review of the World literatura. Clinical Anatomy. 2001; 14 (3): 167-172. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/ca.1028
16. Mitidieri, VC. Anatomía de la vía biliar. Enciclopedia Cirugía digestiva. 2009; (4): 1-11. Available from: http://sacd.org.ar/ctreintaysiete.pdf
17. Mitidieri, V, Ottone NE. La Vía Biliar Intrahepática: Clasificación Anátomo-Quirúrgica con Base Colangiográfica. International Journal of Morphology. 2015; 33(4): 1427-35. Available from: https://scielo.conicyt.cl/scielo.php?pid=S0717-95022015000400039&script=sci_arttext&tlng=en
18. Nagral S. Anatomy relevant to cholecystectomy. J Min Access Surg 2005; 1(2):53-8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004105/
19. RAJguRu J, Mistry P. A. Study of Confluence Pattern of Hepatic Ducts at Porta Hepatis and its Clinical Significance. International Journal of Anatomy, Radiology and Surgery. 2016; 5(4): 12-17. Available from: https://pdfs.semanticscholar.org/a577/2ae8ea80b3e038998bae8f99de0ac31340be.pdf
20. Ramesh Babu CS, Charma M. Biliary Tract Anatomy and its Relationship with VenousDrainage. Journal of Clinical and Experimental Hepatology . 2014; 4(1): S19-S26 . Available from: https://www.sciencedirect.com/science/article/pii/S0973688313005495
21. Sarawagi R, Sundar S, Raghuvanshi S. Anatomical variations of cystic ducts in magnetic resonance cholangiopancreatography and clinical implications. Radiology research and practice 2016; 2016: 1-6 Available from: https://www.hindawi.com/journals/rrp/2016/3021484/abs/
22. Sirisha, V, Udaya Kumar P, Naveen Kumar B,Kalpana T. A Study on the Variations in cystic duct: Clinical and embryological evaluation. Int J Anat Res 2017; 5(3.2):4308-12 Available from: http://www.ijmhr.org/ijar.htm
23. Talpur, KAH, 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. The Journal of the Pakistan Medical Association. 2010; 60(2): 89-93. Available from: https://www.researchgate.net/profile/Arshad_Malik8/publication/41823083_Anatomical_variations_and_congenital_anomalies_of_Extra_Hepatic_Biliary_System_encountered_during_Laparoscopic_Cholecystectomy/links/5474a63d0cf2778985abed85/Anatomical-variations-and-congenital-anomalies-of-Extra-Hepatic-Biliary-System-encountered-during-Laparoscopic-Cholecystectomy.pdf
24. Turner, MA, Fulcher AS. The cystic duct: normal anatomy and disease processes. Radiographics. 2001; 21 (1): 3-22. Available from: https://pubs.rsna.org/doi/full/10.1148/radiographics.21.1.g01ja093
25. Vakili K, Pomfret EA. Biliary anatomy and embryology. Surgical Clinics. 2008; 88(6): 1159-74. Available from: https://www.sciencedirect.com/science/article/pii/S0039610908000947
26. Van Eijck FC, Van Veen RN, Kleinrensink GJ, Lange JF. Hartmann’s gallbladder pouch revisited 60 years later.Surgical endoscopy. 2007; 21.(7): 1122-25. Available from: https://link.springer.com/article/10.1007/s00464-006-9058-y
Published
2018-10-21
How to Cite
SALDARRIAGA TELLEZ, Bladimir et al. Morphological expression of the extrahepatic bile duct. A study in a sample of Colombian mestizo population. International Archives of Medicine, [S.l.], v. 11, oct. 2018. ISSN 1755-7682. Available at: <http://imedicalsociety.org/ojs/index.php/iam/article/view/2830>. Date accessed: 20 jan. 2019. doi: https://doi.org/10.3823/2585.
Section
Human Anatomy