Anomalous biliary duct mistaken as hilar stricture: A case report

Abstract

Anomalous biliary anatomy is frequently encountered by surgeons during cholecystectomy. Importance of its recognition lies in avoiding serious biliary injuries. One such anomaly is cholecystohepatic duct. We describe rare clinical situation wherein agenesis of CHD along with cholecystohepatic duct was mistaken for hilar stricture.

Klatskin-Like Lesions

“…Heterotopic pancreatic tissue is commonly found in the stomach and duodenum but may occur in the hilar confluence [ 123 ] as can heterotopic gastric mucosa [ 124 ]. Cholecystohepatic duct with absence of common hepatic duct where the right and left ducts drain into the gall bladder has been mistaken for a malignant hilar stricture on preoperative imaging [ 125 ]. Idiopathic nonspecific fibrosis of hilar ducts has also been reported in many series [ 10 , 126 , 127 ].…”

Cholecysto-hepatic duct serving as the only drainage pathway of bile from the intrahepatic to the extrahepatic biliary system in an infant: a case report

“…The normal most frequent biliary anatomy is as follows: Peripheral intrahepatic bile ducts start in the center of hepatic lobules, run along the portal venous and hepatic arterial branches towards the center, and successively merge to form the sub-segmental and segmental hepatic branches. The segmental ducts of second and third (lateral segmental branches) and fourth (medial segmental branch) hepatic segments form the left hepatic duct (LHD), the fifth and eighth segmental ducts together form the right anterior [5] or ventrocranial duct, and the sixth and seventh segmental ducts form the right posterior (RPD) or dorsocaudal duct [4]. The RAD and RPD then merge together as the right hepatic duct (RHD).…”

“…These anomalies, in the order of prevalence, include: (1) Drainage of the RPD to LHD, CHD, or CD (the crossover anomaly). (17-18.4%), (2) The hepatic ductal trifurcation, where the RPD, RAD and LHD merge in a single point (5-19%), (3) Drainage of the RHD to the CD or CHD, (4) The cystic duct insertion to the medial wall of the CHD, which is extremely important to know upon the cholecystectomy procedure, (10-18%) (5) The CD insertion to the distal third of the common duct which is called the CD low insertion (8-11%), ( 6) A parallel course of the CD in close approximation with the CHD for more than 2 cm, which is called the long parallel course, (7.5%) (7) Insertion of the CD to the RHD, high insertion of the CD to CHD, double CD and short CD, that are noted in rare cases, [4] (8) Subvesical bile ducts or cholecystohepatic ducts, which we discuss in greater detail in the following paragraph, are the ones which drain from the right hepatic segments directly into the gallbladder or the CD.…”

“…Cholecystohepatic duct is an uncommon anomaly of the biliary system and occurs in 0.7-1.2% of the population [1,2]. Only 29 cases of cholecystohepatic duct with agenesis of CBD/CHD are reported in the literature since 1945 [5][6][7]. In this rare anomaly, bile drains into the gallbladder which is connected to duodenum via cystic duct with agenesis of the CBD or CHD [8].…”

Embryological Basis and Clinical Correlation of the Rare Congenital Anomaly of the Human Gall Bladder: - “The Diverticulum” - A Morphological Study

“…The most unique feature of the so called normal anatomy of the extra-hepatic biliary system is its high degree of variability, wherein classical textbook anatomy of the biliary tract is seen in less than 50 % of cases [6].…”