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

 

Common Bile Duct and Hepatic Artery: 1

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

   
 

The common hepatic duct is formed by the junction of right and left hepatic ducts in the liver hilum (see biliary variations). The entrance of the cystic duct is highly variable but is most commonly a short distance beyond the hepatic ducts. The duct below the cystic duct is called the common bile duct and has a short supraduodenal segment. The duct then enters the substance of the pancreatic head and curves laterally to drain into the duodenum, usually the second part, occasionally more distal, rarely more proximal. It is joined near the duodenal wall by the pancreatic duct and a common ampullary channel is formed in most individuals. The remainder have separate duodenal openings.    

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Common Bile Duct and Hepatic Artery: 2

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

   
 

The common hepatic artery usually arises from the celiac trunk and passes downward to the right beneath the posterior peritoneum of the lesser sac toward the base of the hepatoduodenal ligament. There it gives rise to the gastroduodenal artery. The gastroduodenal passes between the duodenal bulb and the head of the pancreas. It gives off a retroduodenal branch which passes in front of the bile duct and over the superior border of the pancreas to descend on the deep surface of the head as the posterior superior pancreaticoduodenal artery. The continuation of the hepatic artery beyond the gastroduodenal turns upward into the hepatoduodenal ligament and is called the proper hepatic artery. It gives off the right gastric artery and passes toward the liver hilum in front of the portal vein and to the left of the bile duct. It divides into right and left hepatic arteries. The right usually passes behind the common hepatic duct and right hepatic duct where it gives off the cystic artery. The cystic artery divides into a deep branch running in the gallbladder bed and a superficial branch on the free surface of the gallbladder. Right and left hepatic artery variations each occur in about 15% of individuals. 

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Common Bile Duct and Hepatic Artery: 3

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

   
 

The supraduodenal bile duct receives its blood supply from the hepatic and cystic arteries above and from the gastroduodenal and retroduodenal arteries below. The fine network of vessels from above and below form a delicate epicholedochal plexus on the surface of the duct. The dominant blood supply to the watershed area comes from below. The plexus is easily injured by dissection and cautery and the injury may result in later stricture.     

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