Korean J Radiol.  2003 Jun;4(2):85-90. 10.3348/kjr.2003.4.2.85.

Anatomic Variation in Intrahepatic Bile Ducts: an Analysis of Intraoperative Cholangiograms in 300 Consecutive Donors for Living Donor Liver Transplantation

• Choi JW
• Kim TK
• Kim KW
• Kim AY
• Kim PN
• Ha HK
• Lee MG

• KMID: 1118810
• DOI: http://doi.org/10.3348/kjr.2003.4.2.85

Abstract

OBJECTIVE
To describe the anatomical variation occurring in intrahepatic bile ducts (IHDs) in terms of their branching patterns, and to determine the frequency of each variation. MATERIALS AND METHODS: The study group consisted of 300 consecutive donors for liver transplantation who underwent intraoperative cholangiography. Anatomical variation in IHDs was classified according to the branching pattern of the right anterior and right posterior segmental duct (RASD and RPSD, respectively), and the presence or absence of the first-order branch of the left hepatic duct (LHD), and of an accessory hepatic duct. RESULTS: The anatomy of the intrahepatic bile ducts was typical in 63% of cases (n=188), showed triple confluence in 10% (n=29), anomalous drainage of the RPSD into the LHD in 11% (n=34), anomalous drainage of the RPSD into the common hepatic duct (CHD) in 6% (n=19), anomalous drainage of the RPSD into the cystic duct in 2% (n=6), drainage of the right hepatic duct (RHD) into the cystic duct (n=1), the presence of an accessory duct leading to the CHD or RHD in 5% (n=16), individual drainage of the LHD into the RHD or CHD in 1% (n=4), and unclassified or complex variation in 1% (n=3). CONCLUSION: The branching pattern of IHDs was atypical in 37% of cases. The two most common variations were drainage of the RPSD into the LHD (11%) and triple confluence of the RASD, RPSD and LHD (10%).

Keyword

Bile ducts, anatomy; Bile ducts, abnormalities; Bile ducts, radiography

Figure

• 

  Fig. 1 Schematic drawing of IHD anatomy. Type 1 is typical. Type 2 involves triple confluence, the simultaneous emptying of the RASD, RPSD and LHD into the CHD. In type 3, the RPSD drains anomalously, and in type 4, the RHD drains into the cystic duct. In type 5, an accessory duct is present, and in type 6, segments II and III drain individually into the RHD or CHD. Type 7 shows unclassified or complex variation. R=right hepatic duct, L=left hepatic duct, RA=right anterior segmental duct, RP=right posterior segmental duct, C=cystic duct, Acc=accessory duct

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  Fig. 2 Typical IHD anatomy (type 1). Operative cholangiogram shows that the CHD is formed by fusion of the RHD and LHD (asterisks). The RHD is formed by fusion of the RASD (small arrows), which drains anterior segments V and VIII, and the RPSD (large arrows), which drains posterior segments VI and VII.

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  Fig. 3 Triple confluence (type 2). Operative cholangiogram demonstrates simultaneous emptying of the RASD (small arrows), RPSD (large arrows) and LHD (asterisks) into the CHD.

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  Fig. 4 Anomalous drainage of the RPSD (type 3). A. Drainage of the RPSD into the LHD (type 3A). B. Drainage of the RPSD into the CHD (type 3B). Each operative cholangiogram depicts drainage of the RPSD (large arrows) into the LHD (asterisk) and CHD, respectively. Small arrows=RASD

• 

  Fig. 5 Drainage of the RHD into the cystic duct (type 4). Operative cholangiogram shows the RHD (arrowheads), formed by fusion of the RASD (small arrows) and RPSD (large arrows), into the cystic duct. Asterisks=LHD

• 

  Fig. 6 Accessory hepatic ducts (type 5). A. Drainage of an accessory hepatic duct into the CHD (type 5A). B. Drainage of an accessory hepatic duct into the RHD. Operative cholangiograms indicate that accessory hepatic ducts (arrowheads) drain into the CHD and RHD, respectively. Small arrows=RASD, large arrows=RPSD

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  Fig. 7 Segments II and III of the segmental duct drain individually into the RHD or CHD (type 6). Operative cholangiogram shows that segmental duct branches S2 (large arrows) and S3 (arrowheads) drain into the CHD. There is no left main duct.

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  Fig. 8 Unclassified or complex variation (type 7). Cholangiogram shows type-3 trifurcation, with the accessory right posterior segmental duct (arrowheads) pouring into the caudate branch of the bile duct. Large arrows=RPSD, small arrows=RASD, asterisks=LHD

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