The Prevalence of Hjortsjo Crook Sign of Right Posterior Sectional Bile Duct and Bile Duct Anatomy in ERCP.

Hanan M Alghamdi,Bander F Aldhafery,Abdulaziz Alqurain,Raed M Alsulaiman,Afnan F Almuhanna,Ahmed Almarhabi

doi:10.1155/2017/2532610

Hanan M Alghamdi, Bander F Aldhafery + Show 4 more

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https://doi.org/10.1155/2017/2532610

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Abstract

Aim The frequency of the Right Posterior Sectional Bile Duct (RPSBD) hump sign in cholangiogram when it crosses over the right portal vein known as Hjortsjo Crook Sign and the bile duct anatomy are studied. Knowledge of the implication of positive sign can facilitate safe resection for both bile duct and portal vein. Methods Prospectively, we included 237 patients with indicated ERCP during a period from March 2010 to January 2015. Results The mean age (±SD) and male to female ratio were 38.8 (±19.20) and 1 : 1.28, respectively. All patients are Arab from Middle Eastern origin, had biliary stone disease, and underwent diagnostic and therapeutic ERCP. Positive Hjortsjo Crook Sign was found in 17.7% (42) of patients. The sign was found to be equally more frequent in Nakamura's RPSBD anatomical variant types I, II, and IV in 8.4% (20), 6.8% (16), and 2.1% (5), respectively, while rare anatomical variant type III showed no positive sign. Conclusion Hjortsjo Crook Sign frequently presents in RPSBD variation types I, II, and IV in our patients.

Highlights

The anatomy of the bile duct (BD) is resembling that of the portal system and liver segments
Recognition of Hjortsjo Crook Sign (HCS) in ERCP can enrich our preoperative knowledge of biliary anatomical variation; their precise delineation and anticipation for technical modifications are vital to achieving safe curative liver resection [3] and liver transplantation [4, 6,7,8] and to avoiding biliary injury in common general surgical procedure like cholecystectomy [9,10,11]
Our study describes the characteristics of HCS of the Right Posterior Sectional Bile Duct (RPSBD) anatomy in relation to the right portal vein (RPV) among Middle Eastern population using ERCP cholangiogram

Summary

Introduction

The anatomy of the bile duct (BD) is resembling that of the portal system and liver segments. Nakamura’s operative series report the supraportal RPSBD to be most common in BD variant type I (65%, the classic form where the RPSBD and the anterior sectional BD join to form a single right hepatic duct), type II (9.2%, the RPSBD joins the confluence, forming trifurcation), and type IV (15.8%, the RPSBD joins the left hepatic duct), whereas the infraportal RPSBD is reported to be most common in type III (8.3%) and that of the combination in type V (1.7%) [4]. Our study describes the characteristics of HCS of the RPSBD anatomy in relation to the right portal vein (RPV) among Middle Eastern population using ERCP cholangiogram. The relation of the different anatomical variation of the RPSBD to the RPV based on HCS has never been examined before in humans

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