Investigation of Biliary Canal Variations as a Cause of Stone Formation in the Choledochal Canal

Abstract

The present study aimed to investigate if there is an association between the diameter of the choledochal duct and choledochal duct stone formation. The present study consisted of 79 patients who had endoscopic interventions and MRCP procedure with surgery history. Some followed due to disorders of the liver, gall bladder, and biliary tract and some of whom presented hepatobiliary complaints between 2017 and 2019. The choledochal duct diameter measured from MRCP images and choledochal duct stone had examined; the type classified according to Huang classification. Among the cases classified, 29 patients, was Huang Type A1, 27 patients were Huang Type A2, 16 patients were Huang Type A3, and seven patients were Huang Type A4. There was not any statistically significant association in terms of choledochal diameter regarding the types. Choledochal duct diameter was statistically higher in female patients than male patients (p<0.05). According to the age group, a statistically significant difference detected for choledochal duct stone formation; individuals over 45 years of age present an increase for choledochal duct stone (p<0.05). The choledochal duct diameter was found higher in female patients compared with male patients; stone formation has found increased in both gender over 45 years of age. It should consider before surgical procedures and radiological tests.

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

“…In order to calculate the global prevalence of each variation, we conducted a systematic literature search using medical archiving platforms. We retrieved 47 articles that reported on variations in intra-hepatic biliary ductal anatomy in a total of 17045 persons[ 3 , 5 - 50 ]. Table 2 summarizes the data extracted from published reports of intra-hepatic bile duct variations across the globe.…”

“…We did not encounter any persons with type A5 variants in our population. This was not surprising as many authors published series without identifying A5 variants[ 3 , 5 , 8 , 10 , 14 , 16 - 19 , 21 , 23 - 25 , 27 , 35 , 36 , 41 , 45 , 46 , 50 ]. In the general medical literature, the frequency of A5 variants ranged from 0.05[ 42 ] to 9.3%[ 15 ] and we calculated the global prevalence of A5 variants to be 0.58%.…”

“…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.…”

“…This “classic” anatomic pattern was present in 71.7% of unselected persons in our population. In the general medical literature, the prevalence of the “classic” anatomic pattern ranged from 36.7%[ 50 ] to 80%[ 23 ]. Wietzke-Braun et al [ 21 ] reported type A1 variants in only 11% of their population.…”

“…The most common variant we encountered was a triple confluence (A2), occurring in 19.5% of unselected individuals. In the general medical literature, the prevalence of a trifurcation ranges from 0.8%[ 14 ] to 34.2%[ 50 ] and the calculated global prevalence was 11.5%. Therefore, in our population there was a significantly greater prevalence of A2 trifurcations (19.1% vs 11.5%; P = 0.0069).…”