A study of the anatomic variations of the pancreatico-biliary system in Palestine: a national study

Abstract

Background: The objective of this study is to assess the frequency of anatomic variations of the biliary system in the Palestinian population in patients undergoing MRCPs.Methods: For a period of 3 years, from March 2016 to January 2019, a total of 401 MRCPS were performed in different Palestinian Medical Centers for different indications. 346 Images were included in the study. Images were evaluated independently by two expert radiologists for the presence of variations in the anatomy of gallbladder, cystic duct, common bile duct, pancreatic duct, pancreas and intrahepatic ducts.Results: About 78% of the images had normal anatomy of Intra-hepatic ducts. Right posterior duct joining the right anterior duct by its lateral side was observed in 12.6% of images and triple confluence in 8.5% of images. About 12% of the gallbladder images have anatomical variation; multi-septate in 4.1% of images and ectopic in 3.7% images. For the cystic duct, it was abnormally low in 9.6% of images and high in 5.3% of images. The cystic duct was found parallel in 2.3% of images. Variations of the pancreatic duct were evident in 3.9% of the images.Conclusions: anatomical variations of the pancreatico-biliary system are common and they are worth the attention to prevent major complications during hepatobiliary surgeries.

Anatomic variations of the intra-hepatic biliary tree in the Caribbean: A systematic review

“…Evaluating this from another perspective, most authors who proposed a classification system found anomalies that did not fit into their classifications: 1% by Choi et al [ 11 ], 2% by Khanduja et al [ 41 ], 3.3% by Couinaud[ 5 ], 11.1% by Karakas et al [ 27 ], 34% by Champetier[ 53 ]and 9.4% by Ohkubo et al [ 13 ]. In the general medical literature, the classification proposed by Huang et al [ 3 ] was the most commonly utilized system[ 3 , 8 , 10 , 16 , 25 , 26 , 34 , 41 , 45 , 48 - 50 ]. Therefore, we used the Huang classification to characterize variations encountered in our population.…”

“…The second most prevalent anomaly was a type-A3 variant that was present in 4.6% of our population. In the medical literature the prevalence of type 3 variations ranges from 0.6%[ 48 ] to 30%[ 5 , 36 , 46 ] and the global prevalence was calculated to be 11.5%. Type A3 variants are clinically significant for many reasons.…”

“…The type A4 variant was present in 3.95% of our population. The prevalence of this variant in the general medical literature ranges from 0.3%[ 48 ] to 15.8%[ 9 ] and the calculated global prevalence was 6.4%. General surgeons should make an effort to identify A4 variants before performing laparoscopic cholecystectomy because the abnormal RPSD might be mistaken as the cystic duct[ 33 ], putting it at risk for inadvertent bile duct injury.…”

Trato Biliar: Variações Anatômicas E Sua Importância Na Prática Cirúrgica

“…Sabe-se que este procedimento é feito de forma frequente, diariamente na maioria os lugares do mundo. Também se reconhece que a maioria das lesões iatrogênicas das vias biliares acontecem justamente em colecistectomias [7][8][9] , seja por videolaparoscopia ou laparotômica.…”

Congenital Anomaly of Gall Bladder Assessed Through Magnetic Resonance Cholangiography in Relation to Its Clinical Relevance

“…There are many anatomical variances such as choledulco cysts, fusiform gallbladders, accessory ducts, intrahepatic gallbladders, and Phrygian cap 3,4 . During development, gallbladder sometimes shows rare anomalies known as a Phrygian cap that is the folding of over its fundus part 5,6 with 4% of prevalence rate. The term "Phrygian cap" was used when cap was worn out by Hellenic language slaves for indication of freedom / head garment well worn by residents of geographical area (present Turkey) in 1200 -700 before Christ.…”