scholarly journals Anatomical Variations of Cystic Ducts in Magnetic Resonance Cholangiopancreatography and Clinical Implications

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Radha Sarawagi ◽  
Shyam Sundar ◽  
Sanjeev K. Gupta ◽  
Sameer Raghuwanshi
Keyword(s):  
Magnetic Resonance ◽  
Cystic Duct ◽  
Imaging Modality ◽  
Hepatic Duct ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Anatomical Variations ◽  
Common Hepatic Duct ◽  
Clinical Implications ◽  
Imaging Features ◽  
Type Iv

Background. Anatomical variations of cystic duct (CD) are frequently unrecognized. It is important to be aware of these variations prior to any surgical, percutaneous, or endoscopic intervention procedures.Objectives. The purpose of our study was to demonstrate the imaging features of CD and its variants using magnetic resonance cholangiopancreatography (MRCP) and document their prevalence in our population.Materials and Methods. This study included 198 patients who underwent MRCP due to different indications. Images were evaluated in picture archiving communication system (PACS) and variations of CD were documented.Results. Normal lateral insertion of CD at middle third of common hepatic duct was seen in 51% of cases. Medial insertion was seen in 16% of cases, of which 4% were low medial insertions. Low insertion of CD was noted in 9% of cases. Parallel course of CD was present in 7.5% of cases. High insertion was noted in 6% and short CD in 1% of cases. In 1 case, CD was draining into right hepatic duct. Congenital cystic dilation of CD was noted in one case with evidence of type IV choledochal cyst.Conclusion. Cystic duct variations are common and MRCP is an optimal imaging modality for demonstration of cystic duct anatomy.

scholarly journals Surgical approach to a left-sided gallbladder

2019 ◽  
Vol 12 (8) ◽  
pp. e230681
Author(s):  
Ryan Pereira ◽  
Marlon Perera ◽  
Matthew Roberts ◽  
John Avramovic
Keyword(s):  
Cystic Duct ◽  
Imaging Modality ◽  
Hepatic Duct ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Falciform Ligament ◽  
Biliary Colic ◽  
Common Hepatic Duct ◽  
Critical View Of Safety ◽  
Symptomatic Gallstones ◽  
The Right

Biliary colic is a pain in the right upper quadrant or epigastrium thought to be caused by functional gallbladder spasm from a temporary obstructing stone in the gallbladder neck, cystic duct or common bile duct. A 56-year-old man presented with frequent episodes of typical biliary colic. At initial laparoscopy, the gallbladder was absent from its anatomic location. Further inspection revealed a left-sided gallbladder (LSGB), suspended from liver segment 3. Preoperative ultrasound, the most common imaging modality for symptomatic gallstones, has a low positive predictive value for detecting LSGB (2.7%). Laparoscopic cholecystectomy (LC) was delayed to attain additional imaging. A magnetic resonance cholangiopancreatography demonstrated the gallbladder left of the falciform ligament with the cystic duct entering the common hepatic duct from the left. The patient underwent an elective LC 8 weeks later. The critical view of safety is paramount to safe surgical dissection and could be safely achieved for LSGB.

ANATOMIC VARIANTS OF INTRAHEPATIC BILE DUCTS AND CYSTIC DUCTS IN SAUDI ARABIA: MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY ANALYSIS IN LIVER DONORS

2021 ◽  
pp. 30-32
Author(s):  
Ayesha Nuzhat ◽  
Maram AlGhamdi ◽  
Abdullah AlAyed
Keyword(s):  
Saudi Arabia ◽  
Bile Duct ◽  
Magnetic Resonance ◽  
Cystic Duct ◽  
Hepatic Duct ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Radiology Department ◽  
Common Hepatic Duct ◽  
Left Hepatic Duct ◽  
Liver Donors

Background: Data regarding the pattern of the anatomical variations of biliary tree from the Middle East is considerably decient when compared with the literature available elsewhere. To dete Objective: rmine anatomic variation in branching pattern of intra hepatic bile duct and cystic duct on Magnetic resonance Cholangiopancreatography in liver donors from Saudi Arabia. Methods: This descriptive study was done at Radiology Department Prince Sultan Military Medical City Riyadh, KSA between 2019-2020 after taking IRB approval (IRB No:1404) and collecting data of liver donors (n=92) using Magnetic resonance cholangiopancreatography. Result: Regarding the right hepatic duct, in our study Type A1(69.6%) was predominant followed by Type A2(16.3%). As for the left hepatic duct, typical pattern Type A was observed in 94.6% cases. Drainage of right posterior hepatic duct into left hepatic duct, A3(7.6%) and A4(5.4%) drainage of right posterior hepatic duct into the common hepatic duct were the most common variants in our study. Accessory bile duct with segment 5 draining into CHD with segment 5and 8 draining into CHD was found in 2.2% of cases, and an aberrant bile duct in 1.1% In our study, majority (97.8% )had lateral insertion of cystic duct and in 1.4% accessory cystic duct was noted. Because of growing trend found in Conclusion: number of liver transplant surgeries being performed, magnetic resonance cholangiopancreatography (MRCP) has become optimal for noninvasive evaluation of abnormalities of the biliary tract.

scholarly journals Hepatolitiasis: Kasus Serial di RSUD Dr. Soetomo

2018 ◽  
Vol 2 (1) ◽  
pp. 5 ◽  
Author(s):  
Made Mahayasa ◽  
Tommy Lesmana
Keyword(s):  
Bile Duct ◽  
Magnetic Resonance ◽  
Common Bile Duct ◽  
Gall Bladder ◽  
Hepatic Duct ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Common Hepatic Duct ◽  
Hepatic Bile ◽  
Hepatic Bile Duct

Latar Belakang: hepatolitiasis adalah batu empedu pada saluran empedu liver dengan insidensi 20-30% dari semua pasien yang menjalani operasi untuk penyakit batu empedu. Ada beberapa pilihan operasi hepatolitiasis, seperti hepatektomi, eksplorasi common bile duct (CBD), dan drainase saluran intrahepatik atau cholangioenterostomy (access loop procedures), dan teknik perkutaneus. Pada laporan kasus serial ini, akan dibahas aspek pemilihan operasi pada pasien dengan hepatolitiasis. Kasus: kasus pertama adalah laki-laki, 60 tahun, dirawat di Rumah Sakit Dr. Soetomo dengan nyeri abdomen kuadran kanan atas sejak 2 minggu. Diagnosis dengan USG (ultrasonografi) abdomen dan MRCP (magnetic resonance cholangiopancreatography) menunjukkan terdapat beberapa batu di IHBD (intra hepatic bile duct), CHD (common hepatic duct), CBD, GB (gall bladder), dan sistem bilier yang melebar. Pada pasien dilakukan tindakan kolesistektomi, eksplorasi duktus, dan by pass bilio-digestive Roux en Y (access loop procedures). Kasus kedua adalah perempuan, 45 tahun, dirawat di Rumah Sakit Dr. Soetomo dengan didiagnosis batu IHBD dan CBD. Penderita telah dilakukan kolesistektomi sejak 12 tahun yang lalu. Durante operasi ditemukan atrofi lobus kiri hati. Pada pasien, dilakukan operasi dengan eksplorasi duktus, by pass bilio-digestive Roux en Y (access loop procedures), dan hepatektomi lobus kiri. Simpulan: kasus hepatolitiasis jarang terjadi di Rumah Sakit Dr. Soetomo Surabaya. Diagnosis lengkap memerlukan kombinasi modalitas pencitraan. Pembedahan tetap menjadi pilihan utama pengobatan definitif. Menurut strategi terapeutik saat ini untuk hepatolitiasis, hepatektomi tampaknya merupakan pengobatan yang paling efektif untuk pasien dengan hepatolitiasis kiri yang terisolasi jika prosedur pembedahan lain tidak dapat mengatasi semua lesi terkait. Perawatan yang baik dapat memberikan luaran yang baik.

Clinical aspects and surgical technique in Mirizzi syndrome: A systematic review

2020 ◽  
pp. 35871-35873
Keyword(s):  
Surgical Technique ◽  
Cystic Duct ◽  
Hepatic Duct ◽  
Signs And Symptoms ◽  
Mirizzi Syndrome ◽  
Common Hepatic Duct ◽  
Clinical Aspects ◽  
Main Diagnosis ◽  
Biliary Surgery ◽  
Electronic Library

Mirizzi syndrome is described in the 1940s as follows: partial obstruction of the secondary common hepatic duct by gallstones, impacted on the cystic duct or gallbladder infundibulum, associated with the inflammatory response that involved the cystic duct and the common hepatic duct. As it is a rare and delicate condition, differential diagnosis is extremely important, in which the patient's clinical condition is verified through anamnesis and complementary exams, where immediately after the surgical intervention can be performed. This work aims to describe, through a literature review, the clinical aspects and the surgical technique in Mirizzi Syndrome. Were used as a database for research sites containing scientific articles available online such as Virtual Health Library (VHL), Scientific Electronic Library Online (Scielo) and PubMed. 154 articles were found through the descriptors, where after applying the inclusion and exclusion criteria 11 articles remained to write the work. According to the articles surveyed, it is clear that most of them do not report the syndrome as the main diagnosis, possibly because it is a pathology with signs and symptoms very close to other diseases of the bile duct, therefore leaving the syndrome sometimes described in the context of these other diseases. Finally, it concludes that even though the preoperative diagnosis is rare, it should be suspected in individuals undergoing biliary surgery.

scholarly journals A case of right hepatic duct entering cystic duct successfully treated by laparoscopic subtotal cholecystectomy through preoperatively placed biliary stent

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Hiroki Hirao ◽  
HiroHisa Okabe ◽  
Daisuke Ogawa ◽  
Daisuke Kuroda ◽  
Katsunobu Taki ◽  
...  
Keyword(s):  
Cystic Duct ◽  
Hepatic Duct ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Endoscopic Retrograde ◽  
Case Presentation ◽  
Endoscopic Nasobiliary Drainage ◽  
Subtotal Cholecystectomy ◽  
Upper Abdominal ◽  
The Right ◽  
Nasobiliary Drainage

Abstract Background Laparoscopic cholecystectomy is a well-established surgical procedure and is one of the most commonly performed gastroenterological surgeries. Therefore, strategy for the management of rare anomalous cystic ducts should be determined. Case presentation A 56-year-old woman was admitted to our hospital owing to upper abdominal pain and diagnosed with acute cholecystitis. Magnetic resonance cholangiopancreatography suspected that several small stones in gallbladder and the right hepatic duct drained into the cystic duct. Endoscopic retrograde cholangiopancreatography confirmed the cystic duct anomaly, and an endoscopic nasobiliary drainage catheter (ENBD) was placed at the right hepatic duct preoperatively. Intraoperative cholangiography with ENBD confirmed the place of division in the gallbladder, and laparoscopic subtotal cholecystectomy was safely performed. Conclusions The present case exhibited rare right hepatic duct anomaly draining into the cystic duct, which might have caused biliary tract disorientation and bile duct injury (BDI) intraoperatively. Any surgical technique without awareness of this anomaly preoperatively might insufficiently prevent BDI, and preoperative ENBD would facilitate safe and successful surgery.

EXPERIENCE OF EVALUATION OF PATIENTS OF OBSTRUCTIVE JAUNDICE BY SONOGRAPHY AND MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY AT A TERTIARY CARE CENTRE IN EASTERN INDIA

2021 ◽  
pp. 61-64
Author(s):  
Santosh Kumar Prasad ◽  
Nupur Nupur ◽  
Akshit Pathak ◽  
Indra Shekhar Thakur ◽  
Vijay Shankar Prasad
Keyword(s):  
Magnetic Resonance ◽  
Obstructive Jaundice ◽  
Hepatic Duct ◽  
Tertiary Care ◽  
Pancreatic Head ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Stricture Formation ◽  
Tertiary Care Centre ◽  
Left Hepatic Duct ◽  
Cross Sectional

INTRODUCTION: Jaundice means yellow due to the yellowish discolouration of skin, sclera, and mucous membrane seen in jaundice caused by bilirubin pigment. It is divided in to two forms obstructive(surgical) and non- obstructive (non-surgical). AIM AND OBJECTIVE: To evaluate patients of obstructive jaundice by sonography and magnetic resonance cholangiopancreatography and compare the reporting and ndings by both the modalities. MATERIALS AND METHODS: Cross sectional observational study done from November 2018 to October 2020 and consists of 32 patients who had clinical jaundice and consented to being subjected to both ultrasound and MRCP. OBSERVATIONS:Both USG and MRCP were able to detect extrahepatic CBD dilatation equally in 25 patients. In 5(15.6%) patients USG and MRI both demonstrated intrahepatic mass causing obstruction at the level of conuence of right and left hepatic duct or CHD. Ultrasonography was able to detect the intrinsic mass of the extrahepatic common bile duct in 2(6.2%) patients out of 32 patients in our study population. MRCP could detect the same in 6(18.7%) patients. In our study narrowing of CBD with stricture formation and upstream dilatation of biliary tree was identied in 10(31.2%) patients on MRCP. Ultrasound could diagnose the same in one patient. Both USG and MRCP were able to detect pancreatic head mass as well as pseudocyst. CONCLUSION: The accuracy of MRCP was found to be comparable to that of ERCP for diagnosis of etiology for obstructive jaundice. MRCP allows better lesion characterization and assessment. However, the patchy availability of MR machines become the main achilles heel for the surgeons as well as the radiologists. Hence the valuable role of the omnipresent ultrasonography become immense.

scholarly journals Repeated Plastic Stentings of Common Hepatic Duct for Portal Vein Aneurysm Compression in a Patient Unsuitable for Surgery

2018 ◽  
Vol 12 (3) ◽  
pp. 570-577 ◽  
Author(s):  
Jeffrey Sun ◽  
Cheuk-Kwan Sun ◽  
Cheuk-Kay Sun
Keyword(s):  
Portal Vein ◽  
Surgical Intervention ◽  
Vascular Malformations ◽  
Imaging Modality ◽  
Hepatic Duct ◽  
Therapeutic Option ◽  
Clinical Signs ◽  
Common Hepatic Duct ◽  
Low Grade ◽  
Portal Vein Aneurysm

Portal vein aneurysms are rare vascular malformations with unclear etiologies and optimal treatment guidelines. Although Doppler ultrasonography is the most commonly used diagnostic tool, there is no gold standard imaging modality. Despite recommendations of surgical treatment for symptomatic aneurysms, there are limited options in the management of portal vein aneurysm-related complications in patients unfit for surgical intervention. We describe an 85-year-old man who presented with abdominal pain and low-grade fever with clinical signs consistent with cholangitis. Endoscopic retrograde cholangiopancreatography revealed a common hepatic duct stricture and concomitant intraductal ultrasonography identified adjacent aneurysmal portal vein dilatation. The final diagnosis of portal vein aneurysm was made using contrast computerized tomography scan. The patient was considered unsuitable for surgery due to his advanced age and multiple comorbidities. Instead, an endoscopic biliary plastic stent was inserted as a therapeutic alternative, which successfully achieved complete resolution of symptoms 3 days after the procedure. The patient was regularly followed at the outpatient clinic with repeated stent replacements every 3 to 4 months. After a follow-up of over 3.5 years, the patient remained symptom-free without signs of portal vein aneurysm compression. The result suggests that repeated stent replacements may be a therapeutic option for biliary compression by portal vein aneurysm in patients contraindicated for surgical intervention.

scholarly journals Anatomic Variations of the Right Hepatic Duct: Results and Surgical Implications from a Cadaveric Study

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Theodoros Mariolis-Sapsakos ◽  
Vasileios Kalles ◽  
Konstantinos Papatheodorou ◽  
Nikolaos Goutas ◽  
Ioannis Papapanagiotou ◽  
...  
Keyword(s):  
Bile Ducts ◽  
Hepatic Duct ◽  
Anatomical Variations ◽  
Common Hepatic Duct ◽  
Drainage Pattern ◽  
Left Hepatic Duct ◽  
Surgical Interventions ◽  
Drainage Patterns ◽  
The Common ◽  
The Right

Purpose. Thorough understanding of biliary anatomy is required when performing surgical interventions in the hepatobiliary system. This study describes the anatomical variations of right bile ducts in terms of branching and drainage patterns, and determines their frequency. Methods. We studied 73 samples of cadaveric material, focusing on the relationship of the right anterior and posterior segmental branches, the way they form the right hepatic duct, and the main variations of their drainage pattern. Results. The anatomy of the right hepatic duct was typical in 65.75% of samples. Ectopic drainage of the right anterior duct into the common hepatic duct was found in 15.07% and triple confluence in 9.59%. Ectopic drainage of the right posterior duct into the common hepatic duct was discovered in 2.74% and ectopic drainage of the right posterior duct into the left hepatic duct in 4.11%. Ectopic drainage of the right anterior duct into the left hepatic ductal system and ectopic drainage of the right posterior duct into the cystic duct was found in 1.37%. Conclusion. The branching pattern of the right hepatic duct was atypical in 34.25% of cases. Thus, knowledge of the anatomical variations of the extrahepatic bile ducts is important in many surgical cases.

scholarly journals Imaging of Fibrosis in Chronic Pancreatitis

2022 ◽  
Vol 12 ◽  
Author(s):  
Yasunobu Yamashita ◽  
Reiko Ashida ◽  
Masayuki Kitano
Keyword(s):  
Chronic Pancreatitis ◽  
Magnetic Resonance ◽  
Imaging Modality ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Imaging Modalities ◽  
Diagnostic Tools ◽  
Diagnostic Modality ◽  
Magnetic Resonance Imaging Mri ◽  
Initial Imaging ◽  
Eus Elastography

Chronic pancreatitis (CP) describes long-standing inflammation of the pancreas, which leads to irreversible and progressive inflammation of the pancreas with fibrosis. CP also leads to abdominal pain, malnutrition, and permanent impairment of exocrine/endocrine functions. However, it is difficult to assess CP pathologically, and imaging modalities therefore play an important role in the diagnosis and assessment of CP. There are four modalities typically used to assess CP. Pancreatic duct features are assessed with magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP). However, ERCP is a rather invasive diagnostic modality for CP, and can result in adverse events such as post-ERCP pancreatitis. Computed tomography (CT) is often the most appropriate initial imaging modality for patients with suspected CP, and has high diagnostic specificity. However, CT findings typically only appear in advanced stages of CP, and it is difficult to detect early CP. Endoscopic ultrasonography (EUS) provides superior spatial resolution compared with other imaging modalities such as CT and magnetic resonance imaging (MRI), and is considered the most reliable and efficient diagnostic modality for pancreatic diseases. The EUS-based Rosemont classification plays an important role in diagnosing CP in clinical practice. Evaluation of tissue stiffness can be another option to assess the diagnosis and progression of CP, and MRI and EUS can be used to assess CP not only with imaging, but also with elasticity measurement. MR and EUS elastography are expected to provide new alternative diagnostic tools for assessment of fibrosis in CP, which is difficult to evaluate pathologically.

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