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): 4

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

   
 

The most common variations of the gallbladder involve the shape and attachment to the liver. The gallbladder may be constricted or folded on itself (Phyrigian cap). A constriction may be mistaken for the cystic duct and lead the surgeon to leave a portion of the gallbladder behind. The gallbladder is usually partially embedded in the liver but may be free on a mesentery or totally intrahepatic. The gallbladder is occasionally in an unusual location such as beneath the left lobe or turned posteriorly into Morrison's pouch. Diverticula and partial internal septations are occasionally seen. Partial or complete duplications are less common. With complete duplication, separate cystic ducts may drain into any of the collecting ducts.   

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Biliary Variation (version 1): 5

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

   
 

The cystic duct may vary in shape, length and number. The junction of the cystic duct and gallbladder, the critical area to be visualized in laparoscopic cholecystectomy, may be tapered or abrupt.  The cystic duct may be long or short. The duct may be convoluted and folded on itself and it is often beneficial to divide the cystic artery first to straighten and gain more length on the duct. The infundibulum may have a broad based attachment to the common duct either as an anomaly or as a result of erosion of a stone (Mirizzi's syndrome). Rarely, the cystic duct us duplicated.     

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Biliary Variation (version 1): 6

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

   
 

The cystic duct usually joins the supraduodenal bile duct dividing it nominally into the common hepatic duct above and the common bile duct below. It may, however join the biliary ducts at any location including the junction of hepatic ducts, a normal or an aberrant hepatic duct (usually on the right). In about a third of individuals, there is a variable length of parallel cystic and common duct, often bound together. When doing a biliary bypass using the gallbladder as a conduit, a cholangiogram will confirm the location of the true cystic duct junction above the obstruction. The cystic duct occasionally enters the posterior or left side of the common duct, passing behind the duct to do so. The cystic duct may join an anomalous hepatic duct or the anomalous duct may enter the cystic. The latter case may cause misidentification and disruption of the drainage of a hepatic segment.   

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