Aberrant bile ducts, ‘remnant surface bile ducts,’ and peribiliary glands: Descriptive anatomy, historical nomenclature, and surgical implications

Abstract

The term "aberrant bile ducts" has been used to designate three heterogeneous groups of biliary structures: (1) bile ducts degenerating or disappearing (unknown etiology, diverse locations); (2) curious biliary structures in the transverse fissure; and (3) aberrant right bile ducts draining directly into the common hepatic duct. We report our observations on these three groups. Twenty-nine fresh human livers of stillborns and adults were injected differentially with colored latex and dissected. Adult livers showed portal venous and hepatic arterial branches, and bile ducts not associated with parenchyma, subjacent to and firmly adherent with the liver capsule: elements of ramifications of normal sheaths were present on the liver's surface. These ramifications, having lost parenchyma associated with them, then sequentially lost their portal branches, bile ducts and arterial branches. This process affected the ramifications of the sheaths in the left triangular ligament, adjacent to the inferior vena cava, in the gallbladder bed and anywhere else on the liver's surface and resulted in the presence of bile ducts accompanied by portal venous and/or hepatic arterial branches and not associated with parenchyma for a period of time. This first group represented normal bile ducts that do not meet the criteria of aberration and could be appropriately designated "remnant surface bile ducts." Such changes were not found in the transverse fissures and review of the literature revealed that the curious biliary structures are the microscopic peribiliary glands. The third group met the criteria of aberration and the anatomy of a representative duct is described.

Reconfirmation of the anatomy of the left triangular ligament and the appendix fibrosa hepatis in human livers, and its implication in abdominal surgery

“…El Gharbawy et al. could find neither AFH nor other atrophied tissues in 10 stillborn baby livers . These observations described above will indicate that the AFH is yet to be formed in the livers of the newborn baby.…”

Spatial architecture of biliary tree in mammals: Fractal and Euclidean geometric features

“…However, we rejected this view after we observed similar “unexplained” branches on the different trees in different countries. Thus, we considered that the existence of such “confused” branches is an unusual manifestation of the universe “geometry” and the efforts to explain their existence rationally need to be continued (El Gharbawy et al, 2011). In addition, since the aberrant ducts are not connected to the bile canaliculi network, they will not have the function of bile drainage.…”

An Extremely Rare Bile Leakage: Aberrant Bile Duct in Left Triangular Ligament (Appendix Fibrosa Hepatis)

“…The bile ducts do not have a constant structure, so the surgeons can have undesired surprise during the gastrointestinal system surgery. To avoid these situations, it is necessary to use imaging methods for diagnosis of the biliary tract before surgery, especially in women [ 2 , 3 , 5 , 6 ]. It is somewhat more difficult to predict this situation in cases of previous gastric surgery, such as the one described by Iso et al [ 6 ].…”

“…This variability is more common in women [ 1 ]. This situation can often leave the surgeon in difficult situations during surgery on the liver, bile ducts, pancreas, and upper gastrointestinal tract [ 2 ].…”