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Intrahepatic biliary duct branching patterns, cystic duct anomalies, and pancreas divisum in a tertiary referral center: A magnetic resonance cholangiopancreaticographic study

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Indian Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

Knowledge about anatomic variations in intrahepatic biliary ducts (IHBD) is relevant for performing biliary drainage and for avoiding bile duct injury during cholecystectomy and liver resections. Low insertion of cystic duct (LICD) is a common anatomic variant. Pancreas divisum is the commonest congenital anomaly of pancreas; it has been causally linked with recurrent acute pancreatitis (RAP).

Methods

Magnetic resonance cholangiopancreaticography (MRCP) images of 500 consecutive patients were reviewed for anatomic variants of IHBD, cystic duct, and pancreatic duct.

Results

Anatomy of IHBD could be evaluated in 458 MRCP’s, of these 301 (65.72 %) had ‘typical’ anatomy. The variant in 157 persons included ‘triple confluence’ in 56 (12.23 %), ‘right posterior segmental duct (RPSD) draining to left hepatic duct (LHD)’ in 64 (14 %), ‘RPSD to common hepatic duct (CHD)’ in 20 (4.4 %), ‘RPSD to cystic duct’ in 2 (0.4 %), ‘accessory duct to CHD’ in 3 (0.7 %), ‘accessory duct to right hepatic duct (RHD)’ in 1 (0.2 %), ‘segment 2 and 3 separately to CHD’ in 1 (0.2 %), and complex variants in 10 (2.2 %). Cystic duct could be evaluated in 338 patients; of these, 15 (4.4 %) had LICD. Patients with RAP had pancreas divisum more often than those without any pancreatic disease, (−/−,10 % and −/−, 0.8 %; p = 0.004).

Conclusions

Nearly one third of MRCPs showed atypical IHBD pattern with RPSD draining to LHD being the commonest. LICD was the most common cystic duct variant. Pancreas divisum was more frequent in patients with RAP than in persons without pancreatic disease.

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References

  1. Orlando R 3rd, Russell JC, Lynch J, Mattie A. Laparoscopic cholecystectomy. A statewide experience. The Connecticut Laparoscopic Cholecystectomy Registry. Arch Surg. 1993;128:494–8. discussion 498-9.

    Article  PubMed  Google Scholar 

  2. Cheng YF, Huang TL, Chen CL, Chen YS, Lee TY. Variants of the intrahepatic bile ducts: application in living-related liver transplantation and splitting liver transplantation. Clin Transplant. 1997;11:337–40.

    CAS  PubMed  Google Scholar 

  3. Kao JT, Kuo CM, Chiu YC, Changchien CS, Kuo CH. Congenital anomaly of low insertion of cystic duct: endoscopic retrograde cholangiopancreatography findings and clinical significance. J Clin Gastroenterol. 2011;45:626–9.

    Article  PubMed  Google Scholar 

  4. Bertin C, Pelletier AL, Vullierme MP, et al. Pancreas divisum is not a cause of pancreatitis by itself but acts as a partner of genetic mutations. Am J Gastroenterol. 2012;107:311–7.

    Article  CAS  PubMed  Google Scholar 

  5. DiMagno MJ, Wamsteker EJ. Pancreas divisum. Curr Gastroenterol Rep. 2011;13:150–6.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Choi JW, Kim TK, Kim KW, et al. Anatomic variation in intrahepatic bile ducts: an analysis of intraoperative cholangiograms. Korean J Radiol. 2003;4:85–90.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Taourel P, Bret PM, Reinhold C, Barkun AN, Atri M. Anatomic variants of the biliary tree: diagnosis with MR cholangiopancreatography. Radiology. 1996;199:521–7.

  8. Sharma MP, Ahuja V. Aetiological spectrum of obstructive jaundice and diagnostic ability of ultrasonography: a clinician’s perspective. Trop Gastroenterol. 1999;20:167–9.

    CAS  PubMed  Google Scholar 

  9. Cucchetti A, Peri E, Cescon M, et al. Anatomic variations of intrahepatic bile ducts in a European series and meta-analysis of the literature. J Gastrointest Surg. 2011;15:623–30.

    Article  PubMed  Google Scholar 

  10. Puente SG, Bannura GC. Radiological anatomy of the biliary tract. Variations and congenital abnormalities. World J Surg. 1983;7:271–6.

    Article  CAS  PubMed  Google Scholar 

  11. De Filippo M, Calabrese M, Quinto S, et al. Congenital anomalies and variations of the bile and pancreatic ducts: magnetic resonance cholangiopancreatography findings, epidemiology and clinical significance. Radiol Med. 2008;113:841–59.

    Article  PubMed  Google Scholar 

  12. Ausch C, Hochwarter G, Taher M, et al. Improving the safety of laparoscopic cholecystectomy: the routine use of preoperative magnetic resonance cholangiography. Surg Endosc. 2005;19:574–80.

    Article  CAS  PubMed  Google Scholar 

  13. Kleitsch WP. Anatomy of the pancreas: a study with special reference to the duct system. Arch Surg. 1955;71:795–802.

    Article  CAS  Google Scholar 

  14. Dawson W, Langman V. An anatomical-radiological study of the pancreatic duct pattern in man. Anat Rec. 1961;139:59–68.

    Article  CAS  PubMed  Google Scholar 

  15. Smanio T. Proposed nomenclature and classification of the human pancreatic ducts and duodenal papillae: study based on 200 post-mortems. Int Surg. 1969;52:125–41.

  16. Ueno E, Takada Y, Yoshida I, Toda J, Sugiura T, Toki F. Pancreatic diseases: evaluation with MR cholangiopancreatography. Pancreas. 1998;16:418–26.

    Article  CAS  PubMed  Google Scholar 

  17. Kim HJ, Kim MH, Lee SK, et al. Normal structure, variations, and anomalies of the pancreaticobiliary ducts of Koreans: a nationwide cooperative prospective study. Gastrointest Endosc. 2002;55:889–96.

    Article  PubMed  Google Scholar 

  18. Bernard JP, Sahel J, Giovannini M, Sarles H. Pancreas divisum is a probable cause of acute pancreatitis: a report of 137 cases. Pancreas. 1990;5:248–54.

    Article  CAS  PubMed  Google Scholar 

  19. Delhaye M, Engelholm L, Cremer M. Pancreas divisum: congenital anatomic variant or anomaly? Contribution of endoscopic retrograde dorsal pancreatography. Gastroenterology. 1985;89:951–8.

    Article  CAS  PubMed  Google Scholar 

  20. Lans JI, Geenen JE, Johanson JF, Hogan WJ. Endoscopic therapy in patients with pancreas divisum and acute pancreatitis—prospective, randomized clinical trial. Gastrointest Endosc. 1992;38:430–4.

    Article  CAS  PubMed  Google Scholar 

  21. Chacko LN, Chen YK, Shah RJ. Clinical outcomes and nonendoscopic interventions after minor papilla endotherapy in patients with symptomatic pancreas divisum. Gastrointest Endosc. 2008;68:667–73.

    Article  PubMed  Google Scholar 

  22. Carnes ML, Romagnuolo J, Cotton PB. Miss rate of pancreas divisum by magnetic resonance cholangiopancreatography in clinical practice. Pancreas. 2008;37:151–3.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India

    Ankur Gupta, Praveer Rai & Vivek Anand Saraswat

  2. Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India

    Vivek Singh & Rakesh Kumar Gupta

Authors
  1. Ankur Gupta
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  2. Praveer Rai
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  3. Vivek Singh
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  4. Rakesh Kumar Gupta
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  5. Vivek Anand Saraswat
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Correspondence to Praveer Rai.

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AG, PR, VS, RKG, and VAS declare that they have no conflict of interest.

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The authors affirm that the study was performed in a manner confirming with the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning Human and Animal Rights, and that the authors followed the policy concerning Informed Consent as shown in Springer.com.

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Gupta, A., Rai, P., Singh, V. et al. Intrahepatic biliary duct branching patterns, cystic duct anomalies, and pancreas divisum in a tertiary referral center: A magnetic resonance cholangiopancreaticographic study. Indian J Gastroenterol 35, 379–384 (2016). https://doi.org/10.1007/s12664-016-0693-5

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  • DOI: https://doi.org/10.1007/s12664-016-0693-5

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