SummaryBackgroundPreoperative knowledge of intrahepatic bile duct (IHD) anatomy is critical for planning liver resections, liver transplantations and complex biliary reconstructive surgery. The purpose of our study was to demonstrate the imaging features of various anatomical variants of IHD using magnetic resonance cholangio-pancreatography (MRCP) and their prevalence in our population.Material/MethodsThis observational clinical evaluation study included 224 patients who were referred for MRCP. MRCP was performed in a 1.5-Tesla magnet (Philips) with SSH MRCP 3DHR and SSHMRCP rad protocol. A senior radiologist assessed the biliary passage for anatomical variations.ResultsThe branching pattern of the right hepatic duct (RHD) was typical in 55.3% of subjects. The most common variant was right posterior sectoral duct (RPSD) draining into the left hepatic duct (LHD) in 27.6% of subjects. Trifurcation pattern was noted in 9.3% of subjects. In 4% of subjects, RPSD was draining into the common hepatic duct (CHD) and in 0.8% of subjects into the cystic duct. Other variants were noted in 2.6% of subjects. In 4.9% of cases there was an accessory duct. The most common type of LHD branching pattern was a common trunk of segment 2 and 3 ducts joining the segment 4 duct in 67.8% of subjects. In 23.2% of subjects, segment 2 duct united with the common trunk of segment 3 and 4 and in 3.4% of subjects segment 2, 3, and 4 ducts united together to form LHD. Other uncommon branching patterns of LHD were seen in 4.9% of subjects.ConclusionsIntrahepatic bile duct anatomy is complex with many common and uncommon variations. MRCP is a reliable non-invasive imaging method for demonstration of bile duct morphology, which is useful to plan complex surgeries and to prevent iatrogenic injuries.
Adenocarcinoma of the duodenum is an exceedingly rare condition representing not more than 0.3% to 0.4% of all gastrointestinal tract cancers. Clinical presentation is usually due to partial or complete obstruction of the duodenum. Computed tomography scan has a high accuracy in detecting metastatic spread to stage the disease. CASE REPORT: A 60 year woman presented with chief complaints of persistent bilious projectile vomiting containing undigested food material and pain in the upper abdomen since 6 months. Upper gastrointestinal endoscopy up to 2 nd part of duodenum revealed no abnormality. Contrast enhanced computed tomography (CECT) scan of abdomen showed a dilated stomach and duodenal dilatation up to 4 th part along with a concentric growth seen in the fourth part of duodenum at the duodenojejunal flexure, and multiple retroperitoneal lymph-adenopathy. Exploratory laparotomy revealed a tumor of the duodenojejunal flexure with dilatation of all the parts of duodenum and stomach. The tumor was seen encasing the superior mesenteric vessels and aorta. A palliative gastro-jejunostomy was performed. Patient had an attack of acute myocardial infarction on post-operative day 6th and expired. Histopathology of the specimen confirmed adenocarcinoma of duodenum. CONCLUSIONS: Adenocarcinoma of duodenojejunal flexure is extremely rare and sometimes difficult to diagnose. Computed tomography scan has a high accuracy in detecting the disease and its metastatic spread to stage the disease. For unresectable tumors, palliative gastro-jejunostomy is the treatment of choice.
Recanalized paraumbilical vein is rare but important cause of paraumbilical non pulsatile mass. We report a case of giant recanalized paraumbilical vein in known case of cirrhotic liver disease and portal hypertension mimicking as paraumbilical hernia on clinical examination. B-mode and Doppler study pointed towards the subcutaneous tortuous dilated tubular structure at paraumbilical region showing color flow and extension upto liver surface in parietal wall of abdomen. Venous blood flow demonstrated on color Doppler study. CT study used to make final diagnosis which demonstrated subcutaneous dilated tortuous opacified tubular veins at paraumbilical region extending along the parietal wall of abdomen into hepatic fissure to join portal vein branch.
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