c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

Biliary Variation (version 1): 1

A D V E R T I S E M E N T

   
 

The term "normal anatomy" should not be misconstrued to mean that there is only one normal pattern for any anatomic structure. In fact there are usually multiple normal variations with origins in embryonic development and the most common pattern occurs about 70% of the time in most cases. The next two most common variations often account for 95% or more of individuals, the rarer variations being found 1% of the time or less. Variations that do not cause problems may be termed aberrant or anomalous. When a variant pattern is dysfunctional, it may be termed an anomaly, malformation or abnormality. The bile ducts and the arterial supply of the liver are particularly rich in variations. Although they may not be pathological in their own right, they might lead to surgical misadventure and harm to the patient if the surgeon is not subliminally aware of the possibilities.   

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Biliary Variation (version 1): 2

A D V E R T I S E M E N T

   
 

The hepatic ducts unite near the hilum of the liver (5% of the time within liver substance) to form the common hepatic duct. Most commonly the right segmental ducts join near the hilum to form a short right hepatic duct which in turn joins the left hepatic duct. Occasionally a trifurcation is found without a right hepatic duct. However about one in five individuals has a right posterior segment duct that drains into the left hepatic duct instead. In a small percent of individuals, the right anterior segmental duct drains into the left. Another hepatic duct variation, a right anterior segmental duct branch that lies directly in the gallbladder bed, is found in about a third of individuals and may account for gallbladder bed bile leak postoperatively.    

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Biliary Variation (version 1): 3

A D V E R T I S E M E N T

   
 

Anomalous extrahepatic bile ducts are found in about one tenth of the population and may attach anywhere along the ductal system including to the cystic duct. They are usually found on the right side. If such a duct is mistaken for the cystic duct and divided, an area of the liver may be obstructed. A rare anomaly is absence of a common bile duct with parallel drainage of the right and left lobes. In that case, the gallbladder usually drains into the right duct.     

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This page was last modified on 6/30/1999.