Extrahepatic Biliary Apparatus Research Articles

Study of normal anatomy and variations in gall bladder

Background: The extra hepatic biliary apparatus consists of right and left hepatic ducts, common hepatic duct, gall bladder, cystic duct and common bile duct which collects and delivers the bile from liver to second part of duodenum. Anatomical variations of biliary tree occur with sufficient frequency to be of concern to the surgeons operating in this area. Identification of anatomical details is necessary for accurate detailing of biliary tree to avoid inadvertent damage to biliary ductal system. Objective: To study the normal anatomy and variations of gall bladder by dissection method. Methods: In the present study a total number of 50 adult human livers with lesser Omentum, duodenum and pancreas were collected from the dissected cadavers from the department of anatomy KVG Medical College Sullia and Chamarajanagar institute of medical sciences, Chamarajanagar. The various parameters of the gall bladder and biliary ductal system were recorded and photographed. Observations and results: The following variations were observed in the present study. Hartmann’s pouch was observed in 42% (21/50). Hourglass GB was observed in 2% (1/50). Folded fundus was observed in 2% (1/50). Intrahepatic GB was observed in 4%.

Morphometric study of adult human gall bladder in a cadaver and its clinical importance

Extrahepatic biliary apparatus comprises of gall bladder, cystic duct, hepatic ducts and common bile duct. Gall Bladder is a pear shaped hollow organ, which are situated in contact with the under surface of right lobe of liver. In adult the length is between 7-10 cm, maximum breadth being 3 cm and with a maximum capacity of 50 ml. The morphological and morphometric variations of gall bladder are common. These variations are well studied and documented by the earlier studies but its precise morphological types and its incidence are utmost important during diagnostic and therapeutic procedures. Hence, comprehensive knowledge of variations of gall bladder will be important to avoid complications during surgical procedures and radiological interventions. The study was carried on 50 liver with Gallbladder specimens obtained from 10% formalin fixed cadavers of age group 50-60 years in the department of Anatomy. The gall bladder was observed, dissected carefully and studied for its parameters i.e. length and breadth using Vernier calipers. The variations in shape, its external morphological features and its position were also noted.52% of the gall bladder specimens had length ranging between 7 – 10cms. 68% of the specimens had transverse diameter ranging between 3 – 5cms. Various shapes observed were Pear shape, Hourglass shape, Retort shape, Cylindrical shape and Flask or Irregular shaped. The commonest shape observed and recorded in this study was Pear shaped in 26 specimens (52%). Folded fundus (Phrygian cap) of gall bladder was found in 2 out of 50 specimens (4%) and Hartmann’s pouch was found in 7 out of 50 specimens (14%).The precise knowledge of the various morphological and morphometric variants of the gall bladder is important for the operating Surgeons and Radiologists. The preoperative diagnosis of these variations helps to reduce the complications like bleeding and biliary leaks.

Morphological Variations of the Cystic Duct and its Clinical Significance

Background: Anatomical variations of the cystic duct (CD) are common with an incidence of 18%–23% and are commonly encountered during cholecystectomy. The prevalence of such variations in our region is recorded so as to create awareness to avoid significant ductal injury in biliary surgery. Methodology: This observational cross-sectional study was undertaken on one hundred specimens of liver with extrahepatic biliary apparatus available in the department of anatomy. The morphology of CD was studied with respect to its length, course, mode, and level of union. Descriptive statistical analysis was done. Results: The range of length of the CD varied between 0.6 and 5.5 cm. The mean length of the CD was 2.06 ± 1.142 cm. 15% were short CDs and 3% had long CDs. The CD opened into the right hepatic duct in 2% and there was a triple confluence in 1%. There was a high union of CD with common hepatic duct (CHD) in 7.2% and a low union in 3.1%. The CD joined the CHD at an acute angle in 82.47% laterally and medially in 1.03%, paralleled in 11.3% of which 9.3% had a short parallel course, and 2% had a long parallel course and spiralled either anteriorly or posteriorly in 5.2%. Conclusion: These variations of CD have surgical significance in order to avoid damage to the ducts during surgical procedures, especially with increasing laparoscopic cholecystectomies. Hence, an awareness to look for these variations in preoperative radiological imaging is essential for the surgeons to avoid catastrophes.

A CADAVERIC STUDY ON VARIATIONS OF THE COMMON HEPATIC DUCT

Variations in the anatomy of extrahepatic biliary apparatus (EHBA) has been a subject of extended research due to its clinical implications. Cholecystectomy is the commonly performed abdominal surgeries and its safety requires the adequate appreciation of anatomical abnormalities of the extrahepatic biliary tree to decrease the morbidity and mortality of the surgery. Abnormalities of the major ducts and presence of accessory ducts give rise to preoperative difculties and postoperative complications. Background & objectives: To study the normal anatomy of common hepatic duct and its variations. With the Methods: aim of the above study, a prospective descriptive study was conducted on 55 specimens with reference to the ducts. Different parameters were used as union of right and left hepatic ducts and common hepatic duct measurements and looked for variations such as accessory hepatic ducts. Results & discussion: Extrahepatic union of right and left hepatic ducts seen in 98% cases and intrahepatic union in 2%. Length of common hepatic duct varied from 1.5 to 4.7 cm with an average of 2.9cm. Accessory hepatic ducts were seen in 7 cases (13%) in which 2 joined the common hepatic duct, 1 joined LHD and 3 were to the cystic duct. All the ndings of the ducts are to enlighte Conclusions: n the anatomical knowledge of the anatomists, general and laparoscopic surgeons, oncosurgeons and to the transplant surgeons which are abundantly useful.

Anatomical Variation in Extrahepatic Biliary Apparatus

Background: For several years, the pathology of the biliary system has been the focus of prolonged study. Largely due to their surgical relevance and the simplicity with which they can be treated in cholecystectomies. While interest in extrahepatic bile ducts has been intensified, very rare studies have been performed on the Indian subcontinent. The anatomical differences of the extra-hepatic biliary area were defined in this study, as these variations are important throughout surgical techniques such as laparoscopic cholecystectomy, thus minimising post-operative difficulties. The objective is aim of the research was to observe anatomical differences in the extrahepatic biliary system in Indian cadaveric specimen samples. Subjects and Methods : Sample content consisted of 100 human cadavers of any sex that were dissected. Cadaver specimens from the dissection room were examined. Cadaver specimens were obtained from Mata Gujri Memorial Medical College, Kishanganj, Bihar, Department of Anatomy. By the traditional method of dissection, they were studied. Results: In the current study, the smallest gall bladder observed was around 25ml, while the largest gall bladder was around 120ml. On average, our study recorded around 50 ml of the gall bladder. Congenital anomalies of the gall bladder included Intrahepatic, Double, Bilobed and separate mesentery. Further, the pathological findings accounted for 20% of total cases and a solitary pathology involving carcinoma was noted. Conclusion: Anatomical variants of the extrahepatic biliary system are widespread and are important for surgeons to prevent injury as critical structures through surgical operations and increase surgical results by recognising them.

Anomalous anatomical variation in extrahepatic biliary tree and pancreas and its related vessels: a cadaveric study

Background: Congenital anamolies of extrahepatic biliary apparatus and pancreas have long been recognized and are of clinical importance because when present may surprise the surgeon during surgery and lead to iatrogenic injuries. Surgeries on extra-hepatic biliary apparatus and pancreas are regularly performed throughout the world. Thus insight into the normal anatomy and congenital variations will reduce complication and definitely improve outcome.Methods: Study was conducted in department of surgery GMC Bhopal and dissection was carried out in Department of Forensic Medicine on 100 cadavers with approval from ethical committee.Results: In 100 cases 70 were male and 30 female. The most common variation in extra hepatic biliary apparatus was short cystic duct was found in 6% cases then formation of common hepatic duct by union of right hepatic duct and left hepatic duct was intrahepatic in 3% cases. There was low insertion of cystic duct with common hepatic duct in 1% case. Cystic artery originating from left hepatic artery in 1% case, in 1% case cystic artery was anterior to common hepatic duct. In Pancreas anterior arterial arcade was absent in 2% cases and its origin varied in 2% case. Posterior pancreatic arcade absent in 1% cases and variation in origin was present in 1% case. The variation in pancreatic duct course was present in 22% cases.Conclusions: Thus significant variation was seen and it could definitely be helpful to hepatobiliary, laproscopic surgeons, radiologist and will further contribute to literature on variation of extrahepatic biliary apparatus and pancreas and its related vessels.

Study of Abnormal Anatomical Variations in Extrahepatic Biliary Apparatus and Its Related Vessels in Cadavers

Background: In the current era, the laparoscopic procedure such as laparoscopic cholecystectomy, laparoscopic hepatobiliary surgery and other open procedures such as open cholecystectomy, biliary stricture surgery, are performed regularly throughout the world and extrahepatic biliary tract is one of the most common sites of the surgical procedures. The incidence of biliary tract injury by laparoscopic cholecystectomy has been found to be higher than open cholecystectomy. Apart from various other causes of biliary injuries aberrant anatomical course of extrahepatic biliary system is a well established fact of iatrogenic ductal injury. Thus, an adequate recognition and awareness of anatomical abnormalities of extra hepatic biliary tree with its vessel, can decrease the morbidity and mortality related to the surgery.

Observational Study of Variations in Termination of the Common Bile Duct in Human Cadaver

Context: The union of the distal portion of the common bile duct and the main pancreatic duct varies. They together may form short common channel or long common channel or may open separately into the second part of the duodenum. So detailed anatomical knowledge is essential for any surgical or endoscopic treatment of this region. Materials and Methods: A cross sectional descriptive type of study was carried out in the department of Anatomy, Sir Salimullah Medical College on sixty two (62) human cadaveric extra hepatic biliary apparatus with pancreatic duct. The samples were collected from unclaimed dead bodies that were under examination in the department of Forensic Medicine of Dhaka Medical College, Dhaka and Sir Salimullah Medical College, Dhaka. The present study was conducted to observe the variations in termination of common bile duct with main pancreatic duct in human cadavers. Results: The common bile duct was found to unite with main pancreatic duct within the duodenal wall in 61.3% cases and outside the duodenal wall in 38.7% cases. Conclusion: The findings of the present study revealed that the termination of the common bile duct varies from individual to individual. DOI: http://dx.doi.org/10.3329/bja.v12i1.22611 Bangladesh Journal of Anatomy, January 2014, Vol. 12 No. 1 pp 11-13

Surgical anatomy of sub-hepatic biliary system

IntroductionThe anatomy of liver and extra-hepatic biliary apparatus has always been the focus of attention among anatomists and surgeons. It has gained greater significance in the recent years in view of technical refinements in the field of cholecystectomy, hepatic surgery and transplantation. Present study emphasizes the normal as well as variations of extra-hepatic biliary apparatus, as most of the published work on the surgical anatomy of the extra-hepatic biliary apparatus refers various ethnic groups variations. Literature on this topic in western U.P. subjects is scanty. MethodA study was conducted on 59 individuals undergoing hepatobiliary surgery after informed consent in the Department of Surgery and on 30 cadavers in the Department of Anatomy, LLRM Medical College Meerut, and Saraswathi Institute of Medical Sciences, Hapur during September 2004 to May 2011. ResultThe study revealed that in all cases, the union of hepatic ducts was extra-hepatic, of which 10% were angular low union and 5% parallel low union. In 95% cases cystic duct had angular union and 4% had parallel type of union with common hepatic duct and in one case cystic duct united with accessory hepatic duct. 16% cases had short cystic duct i.e. 1–2 cm in length. 94% cases show usual relation in hepatoduodenal ligament and in 6% common bile duct was to the left of hepatic artery. DiscussionThe obtained results presented variations regarding certain parameters when compared to previous studies and they represent the ethnic parameters of western UP.

A Study on the Anomalies of Gallbladder and Associated Structures

The gallbladder is a piriform structure on the undersurface of liver. It collects bile from the liver to concentrate it and to store it. The gallbladder has a cystic duct which joins the common bile duct and through these ducts bile passes into the duodenum. There is usually a single gallbladder (arising from the cystic bud of hepatic diverticulum) with one cystic duct supplied by a cystic artery taking origin from the right hepatic artery. But in few persons there are double gallbladder or double cystic ducts or different variations in the origin and course of cystic arteries. A study was undertaken in 2006 to detect the anomalies of these structures among the people Kolkata (a metropolis of eastern part of India), by dissection of cadavers. This study was conducted from the year 2006 to 2009 in the Department of Anatomy of Calcutta National Medical College and in other medical colleges of Kolkata. Three cases of double gallbladder and few other variations like double cystic duct were found in this study. These findings will help the clinicians (specially the surgeons, radiologists of the eastern part of India) to undertake any investigative or surgical procedure in the region of extra hepatic biliary apparatus. This study will enhance our knowledge not only surgical Anatomy, but also in embryology and in gross anatomy.

Incomplete Cantrell's Pentalogy-A Case Report.

We present a case of an 11-year-old boy, who presented to us with a ventral hernia since birth. He was found to have the following: A large ventral midline defect starting from umbilicus to xiphisternum. Sternum was bifid at the lower end. Liver had three separate lobes. Extrahepatic biliary apparatus was normal and liver was ptotic. Diaphragm had an anterior midline defect. Diaphragmatic defect was in continuity with pericardial defect and heart could be seen directly pulsating through the skin. Despite modern surgical standards, Cantrell's syndrome represents a challenge to the surgeon because of the wide spectrum of anomalies, the severity of the abdominal and cardiac malformations, and the high mortality.

Evaluation Of Branching Pattern Of Hepatic Artery

The incidence of normal hepatic arterial anatomy ranges between approximately 50-80% 1-6 of individuals. Knowing anomalous origin of hepatic arteries is important for successful cholecystectomy, hepatobiliary and liver transplant surgery. The present work is a descriptive study which emphasizes to document the normal anatomy and different variations of extra hepatic biliary apparatus and was conducted in Department of Surgery and Anatomy, LLRM Medical College, Meerut and SIMS, Hapur. The study revealed that in all cases, the division of proper hepatic artery was extra-hepatic, of which 92% the point of division was proximal to the point of union of hepatic duct, whereas in 8% cases the point of division was higher. In 86%, the right hepatic artery was dorsal to the common hepatic duct. In 4% cases the artery crossed ventral to common hepatic duct. In 93.5% cases branching pattern of common hepatic artery was normal, 1.5% cases showed trifurcation of common hepatic artery with absence of proper hepatic artery, and aberrant or accessory hepatic artery was present in 5% cases. CONCLUSION: familiarity with vascular Anatomy of sub hepatic region is useful for planning and conduct of radiological as well as surgical procedures of upper abdomen including laparoscopic operations of biliary tract.

Variations of the gallbladder in sudanese subjects with literature review

Advances in the use of laparoscopic surgery, especially in the biliary apparatus interference makes the need to revise the anatomical data of the gallbladder (GB) more important. Variations of the extra-hepatic biliary apparatus are characterized by large varieties of configurations. The aim of this article was to study the morphology of the GB in Sudanese subjects and review the common variations. Dissection of formalin-fixed cadavers' abdomens. GB is larger in Sudanese subjects than what is described in the standard text books. Congenital anomalies and anatomical variations of the extra-hepatic biliary tree, although not uncommon, can be of clinical importance. There are some differences in the only size of GB in Sudanese.

Simultaneous gallbladder and bile duct cancers: revisiting the pathological possibilities

The pathogenesis of gallbladder cancer presenting synchronously with malignancy of the bile duct has not been clearly understood. The possible causes for the simultaneous presence of these tumors could be due to local spread, metastases, de novo multifocal origin, or as part of a field change in the extrahepatic biliary apparatus. In this article, we discuss the cases of four patients with simultaneous gallbladder and bile duct malignancies and analyze their individual pathologies to provide an explanation into the mechanisms that may play a role in such conditions.

Multiple tumors of the biliary tract

Multiple synchronous tumors of the extrahepatic biliary tree are not frequently reported. Over a 2-year period, 54 operative procedures were performed for tumors of the extrahepatic biliary tract or periampullary region. In five of these cases, unsuspected tumors were observed. Of these, one patient had multiple benign papillomatosis of the extrahepatic biliary tree. All four of the other patients were found to have unsuspected small carcinomas of the gallbladder in association with mid- or low bile duct cancer. Multiple tumors of the extrahepatic biliary apparatus may occur more frequently than previously thought, and the incidence of unsuspected gallbladder cancer in association with bile duct cancer may be high. These tumors should be suspected and looked for in each instance by intraoperative endoscopy and careful histologic examination of the gallbladder.