Anatomical variations of the cystic duct: Two case reports

Abstract

Anatomical variations of the cystic duct often occur and may be encountered during cholecystectomy. Knowledge of the variable anatomy of the cystic duct and cysticohepatic junction is important to avoid signifi cant ductal injury in biliary surgery. Here, we present two unusual cases with an anomalous cystic duct, namely, low lateral insertion and narrow-winding of the cystic duct. The first case was a 64-year-old man with cholelithiasis and chronic cholecystitis. During surgery, the entrance of the cystic duct was misidentifi ed as being short and leading into the right hepatic duct. Further exploration showed multiple calculi in the right and common hepatic ducts. Cholecystectomy was completed, followed by T-tube drainage of the common and right hepatic ducts. Postoperative T-tube cholangiography demonstrated that the two T tubes were respectively located in the cystic and common hepatic duct. Six weeks later, the retained stones in the distal choledochus were extracted by cholangioscopy through the sinus tract of the T-tube. The second case was a 41-year-old woman, in which, preoperative endoscopic retrograde cholangiopancreatography (ERCP) revealed a long cystic duct, with a narrow and curved-in lumen. The patient underwent open cholecystectomy. Both patients were cured. The authors propose that preoperative ERCP or magnetic resonance cholangiopancreatography (MRCP), and intraoperative cholangiography or cholangioscopy constitute a useful and safe procedure for determining anatomical variations of the cystic duct.

A Study on the Variations in Cystic Duct: Clinical and Embryological Evaluation

“…Preoperative evaluation of the extra-hepatic bile duct increases the surgeon's awareness of variants, especially in potentially difficult operative situations [10,16,17].…”

Low Insertion of the Cystic Duct in the Common Hepatic Duct as a Coincidence with an Onset of a Pancreatic Cephalic Carcinoma

“…Normalnata anatomija vo nekoi drugi studii se procenuva i e dobiena vo над 60% na populacijata [6]. Vo istata golema pregledna studija, insercijata na DC vo DHK vo distalnata tretina (NIDC) se pojavuva vo 9%.…”

“…Vo istata golema pregledna studija, insercijata na DC vo DHK vo distalnata tretina (NIDC) se pojavuva vo 9%. Longitudinalen i paralelen tek na bilijarnite vodovi-DC i DHK, so dol`ina pove}e od 2 cm e prisutna vo 1-25%, zavisno od razli~nite stuдii i serii [6]. Ovoj opis e sepak najblisku i do na{ite oпservacii, definicija i odreduvawe na NIDC, iako postojat trudovi i prikazi na slu~aj kadeшто dolinata na DC e i над 8 cm [7].…”

Normal Anatomy of the Biliary Tree, Gallbladder and Pancreatic Duct

“…2.18). Anatomical variations of the cystic duct are usually of no clinical significance, occurring in 18-23% of cases, but an unrecognized variant anatomy can be a source of confusion in imaging studies [8,24]. There are three common variants in the cystic ductal anatomy: a medial cystic duct insertion, in which the cystic duct drains into the left side of the common hepatic duct (10-17% of cases), with an anterior or posterior spiral aspect; a parallel course of the cystic duct and common hepatic duct, judged to be present when the cystic duct follows a closely adherent course, parallel to the common hepatic duct over at least a segment of 2 cm (1.5-25% of cases) (Fig.…”

“…2.22); cystic duct hypertrophy (diameter >5 mm) (Fig. 2.23); a double cystic duct; a cystic duct inserted directly into the duodenum; and an aberrant fusion of the cystic duct with the right or left hepatic duct [1,24]. Sometimes the cystic duct may join the accessory hepatic duct (Fig.…”