The right and left hepatic ducts join outside of the liver substance 95% of the time to form the common hepatic duct. The right duct is shorter than the left. Five percent of the time there is a subvesical hepatic duct (segment 5, see below) deep to the gallbladder bed. It is injury to this duct and not ducts of Luschka that usually cause bile leakage from the gallbladder bed.
Biliary atresia is now considered to be a secondary phenomenon rather than a failure of development since the liver and ducts originate from the hepatic diverticulum (see biliary embryology). A neonatal inflammatory or viral process (cytomegalovirus, rubella, non A, non B hepatitis, reovirus 3) has been postulated. Cystic disease of the intra and extrahepatic bile ducts occurs in various combinations. Choledochal cysts have a 15% chance of developing malignancy and should be resected.
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