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

Bladimir Saldarriaga Tellez,Edgar Giovanni Corzo Gomez,Luis Ernesto Ballesteros Acuña,Pedro Luis Forero Porras

doi:10.3823/2585

Bladimir Saldarriaga Tellez, Edgar Giovanni Corzo Gomez + Show 2 more

Open Access

https://doi.org/10.3823/2585

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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.

Highlights

The extra hepatic bile duct (EHBD) is formed at the level of the hepatic hilum, by the junction of the right and left hepatic ducts (RHD, LHD), which form the common hepatic duct (CHD)
The CHD joins the cystic duct (CD) and forms the common bile duct or choledoch duct (ChD), which flows into the second portion of the duodenum [1]
In the present study the length of the extrahepatic bile duct (EBD) was determined by the sum of the lengths of the CHD and the supradoudenal segment of the ChD, and the overall length was divided into thirds that accurately determined the level of the hepatic cystic junction, a methodology that we propose be considered in future investigations

Summary

Introduction

The extra hepatic bile duct (EHBD) is formed at the level of the hepatic hilum, by the junction of the right and left hepatic ducts (RHD, LHD), which form the common hepatic duct (CHD). The gallbladder (GB) is lodged in a pit of the visceral face of the liver, is variable in its shape and size, it is generally located between segments IV and V of the liver. It recognizes the fundus, body and neck, which may be partially or completely embedded in the liver parenchyma [2]. At the level of the neck, the GB can present the Hartmann’s pouch (Hp), variable dilation in shape and size, which can hide or limit the visibility of the cystic duct in the hepatobiliary triangle [2]. The objective of this study was to characterize the morphological expressions of EBD

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