Common and Uncommon Anatomical Variants of Intrahepatic Bile Ducts in Magnetic Resonance Cholangiopancreatography and its Clinical Implication

Sarawagi, Radha; Sundar, S; Raghuvanshi, Sameer; Gupta, Sanjeev Kumar; Jayaraman, G.

doi:10.12659/pjr.895827

Cited by 52 publications

(43 citation statements)

References 18 publications

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“…Among seven types of anatomic variants, type 3a with drainage of the RP duct into the LHD was the most common, followed by type 2 (trifurcation), which were present in 16.8% and 13.9% of PD patients, respectively. These rates for control group were 20.4% and 5.1%, respectively, and were compatible with those reported in previous studies (8,14,(20)(21)(22). The most common complications after hepatobiliary surgeries are related to the iatrogenic injuries of bile ducts.…”

Section: Discussionsupporting

confidence: 91%

“…Sarawagi et al (8) reported similar findings in their study. Since ligation or resection of the aberrant duct may lead to complications such as bile leakage, biliary bilioma, and bile peritonitis, knowledge of variations of the right hepatic duct draining into the cystic duct (type 4) is critical.…”

Section: Discussionsupporting

confidence: 80%

“…Familiarity with the bile duct branching pattern and its variations can prevent complications which may occur during the surgical, endoscopic, or percutaneous procedures. During laparoscopic cholecystectomy, resection of the accessory sectoral or segmental ducts may cause bile leakage, bilioma, bile peritonitis, and ligation of the aberrant duct may lead to recurrent cholangitis, hepatic abscess, and atrophy of the involved segment (8).…”

Section: Resultsmentioning

confidence: 99%

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Frequency of bile duct confluence variations in subjects with pancreas divisum: an analysis of MRCP findings

Çoruh

Gülpınar

Baş

et al. 2018

Diagn Interv Radiol

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ongenital anomalies of the pancreatic duct may remain undiagnosed until adulthood and they are often diagnosed incidentally. Pancreas divisum (PD) is the most common congenital anomaly of the pancreas which occurs from a failure of ventral and dorsal bud fusion (1, 2). It accounts for about 4%-14% of the population at autopsy series, and approximately 9% are detected using magnetic resonance cholangiopancreatography (MRCP) (3). In PD, the ventral (Wirsung) duct opens into the major papilla without merging with the dorsal (Santorini) duct. The dorsal duct, which opens into the minor papilla, is responsible for the majority of the drainage from the pancreas. The clinical importance of PD is not clear. Most patients are asymptomatic, whereas in some patients, PD may cause recurrent pancreatitis due to lack of adequate drainage into duodenum via minor papilla (3, 4). Of patients with idiopathic recurrent pancreatitis, 12%-26% have PD (5). There are various type of examinations to evaluate the pancreaticobiliary system; however, MRCP has been shown to be an effective noninvasive imaging modality for the visualization of the biliary tree and pancreatic duct. Bret et al. (6) reported an accuracy rate of 100% in the diagnosis of PD using MRCP (6).Laparoscopic cholecystectomy, transplantation surgery, hepatic resection, and tumor surgery are the most common hepatobiliary surgeries in which complications related to the bile duct variations comprise one of the most common reasons for morbidity and mortality. PURPOSEWe aimed to evaluate the frequency of bile duct branching pattern variations at the hepatic confluence in patients with pancreas divisum (PD). METHODSA search was performed through the hospital database using the keyword "pancreas divisum" to identify patients. The magnetic resonance cholangiopancreatography (MRCP) images of 137 patients who were diagnosed with PD between August 2011 and November 2016 were retrospectively analyzed for the presence of bile duct variations. A control group of 137 patients without PD was established among patients investigated during the same period. Variations of the biliary tract were grouped into seven types according to the McSweeney et al. classification. RESULTSBiliary tract variations were detected in 103 of a total of 274 patients. Fifty-eight PD patients (42.3%) and 45 control patients (32.8%) had bile duct variation at the hepatic confluence level. The patients with PD were more likely to have biliary tract variation compared with the control group; however, it was not statistically significant (P = 0.105). The most common variation in PD patients was type 3a variation (16.8%). CONCLUSIONMRCP studies showed atypical bile duct confluence pattern in nearly half of both PD patients and controls. There was no statistically significant difference in the frequency of anatomic variations at bile duct confluence in patients with PD versus those without PD. Derivation of these structures from different outpouchings in early embryological life may explain this insignificant differ...

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 80%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Frequency of bile duct confluence variations in subjects with pancreas divisum: an analysis of MRCP findings

Çoruh

Gülpınar

Baş

et al. 2018

Diagn Interv Radiol

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“…Due to the labyrinth-like anatomy of the biliary system and frequent anatomical variants [5], the inexperienced operator may be easily confused while performing choledochoscopic examinations. Thus, trainees usually require longer training periods to achieve familiarity with these techniques and to become comfortable with the complex anatomy of the biliary system.…”

Section: Discussionmentioning

confidence: 99%

The Use of Three‐Dimensional Printing Model in the Training of Choledochoscopy Techniques

Tang

Rong

et al. 2018

World j. surg.

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AimTo evaluate the application value of a three-dimensional (3D) printing model in the training of choledochoscopy techniques.Materials and methodsImaging data from two patients with biliary dilatation were used to produce two 3D reconstruction models which were subsequently constructed into 3D printing models (No. 1 and No. 2). Four hepatobiliary surgeons evaluated the anatomical accuracy and academic teaching value of the printed models. Twenty resident trainees with no prior experience in any kind of endoscopic techniques were randomly and symmetrically divided into two groups. The training group (A) used the 3D model No. 1 in the learning of biliary tract anatomy and practice techniques of choledochoscopy. The control group (B) got the virtual 3D image of the same model on computer for learning. After 4 weeks, the model No. 2 was used to reassess the trainees’ subjective and objective progress in anatomy familiarity and choledochoscopy manipulations.ResultsAll consulted surgeons agreed that the 3D models realistically reproduced the anatomy of the biliary system. All trainees in group A agreed or strongly agreed that the 3D models provided good anatomical realism, enhanced their experience in the training of choledochoscopy techniques, and aided in their learning of biliary anatomy. With the practice went on, they increased the accuracy and showed a reduction in operation time on the model No. 1. During final examination with model No. 2, the rate of correct anatomical structure identification in training group was significantly higher than group B (p < 0.05).ConclusionThe 3D printed biliary tract model is an excellent teaching tool in the training of choledochoscopy techniques. The 3D model is anatomically realistic and can improve the trainee’s anatomical knowledge and endoscopic skills.

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“…However, in this case, the segment II bile duct was conveying right lobe posterior segment bile duct instead of being a single duct. The prevalence of type 3A variation of the right biliary duct according to the classification of Huang et al was reported as 14.5%-27.6% (3,4). In the meanwhile, the prevalence of the type 2 variation of the left biliary duct according to the classification of Cho et al (2) was 23.2%-30%.…”

Section: Images Of the Issuementioning

confidence: 97%

Extraordinary biliary variant

Suna

Etık²,

Öcal³

et al. 2017

Turk J Gastroenterol

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Question:A 40-year-old healthy woman was evaluated as a donor candidate for living donor liver transplantation. Her medical history was unremarkable. She had completely normal physical examination and laboratory results. It was seen on endoscopic retrograde cholangiography imaging ( Figure 1a) and magnetic resonance cholangiopancreatography imaging (Figure 1b) that the right lobe posterior segment bile duct opened to the segment II bile duct and that the segment II bile duct merged with the common trunk of segment III and segment IV bile ducts, thus forming the left hepatic bile duct. 2017; 28: 219-20 Extraordinary biliary variant Nuretdin Suna, Diğdem Özer Etik, Serkan Öcal, Haldun Selçuk, Fatih Hilmioğlu Turk J Gastroenterol Images of the Issue

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Common and Uncommon Anatomical Variants of Intrahepatic Bile Ducts in Magnetic Resonance Cholangiopancreatography and its Clinical Implication

Cited by 52 publications

References 18 publications

Frequency of bile duct confluence variations in subjects with pancreas divisum: an analysis of MRCP findings

Frequency of bile duct confluence variations in subjects with pancreas divisum: an analysis of MRCP findings

The Use of Three‐Dimensional Printing Model in the Training of Choledochoscopy Techniques

Extraordinary biliary variant

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