Compression of the common hepatic duct by the right hepatic artery in intrahepatic gallstones

Abstract

Two cases of intrahepatic gallstones with stenosis of the common hepatic duct caused by overriding of the right hepatic artery are described. The probable diagnosis of the compression of the bile duct by the artery was obtained by superimposing a direct cholangiogram on an angiogram. The final diagnosis was made at operation. The first patient was successfully treated by resection of the compressed common hepatic duct with Roux-en-Y hepaticojejunostomy anterior to the right hepatic artery. In the second patient, lateral segmentectomy and cholangiojejunostomy were performed.Arterial anomalies are not infrequent findings during biliary surgery. Variations in position of the cystic or hepatic arteries are well known. It is, however, very rarely reported that the extrahepatic bile duct is compressed by such arteries [I-5].Recently, the present authors experienced 2 cases of intrahepatic gallstones with stenosis of the common hepatic duct, which was caused by overriding of the right hepatic artery. The purposes of this paper are to report these rare cases and to discuss the significance of compression of the biliary tract by the right hepatic artery.

Prebiliary Right Hepatic Artery Resulting in Common Hepatic Duct Compression and Subsequent Intrahepatic Stone Formation: Myth or Reality?

“…Usually, the absence of obstructive symptoms confirms this diagnosis. However, jaundice due to pulsatile RHA has been reported previously [5, 6, 8, 9, 11], and this is known as the right hepatic artery syndrome [5]. The RHA usually runs posteriorly to the bile duct and can result in an inflammatory impingement of the CHD [5, 6, 10].…”

“…The RHA usually runs posteriorly to the bile duct and can result in an inflammatory impingement of the CHD [5, 6, 10]. Two authors [8, 9] have described 3 cases with this syndrome but with distinguishing features: anterior RHA and hepatolithiasis. Tsuchiya et al [9] and Baek et al [8] attributed jaundice and gallstone formation to an aberrant RHA running anteriorly to the CBD.…”

“…Two authors [8, 9] have described 3 cases with this syndrome but with distinguishing features: anterior RHA and hepatolithiasis. Tsuchiya et al [9] and Baek et al [8] attributed jaundice and gallstone formation to an aberrant RHA running anteriorly to the CBD. Whether or not compression of the CHD has led to stones formation is questionable.…”

“…The first case report was criticized by Professor G.B. Ong [9]; he stated that intrahepatic stones formation preceded the obstructive symptoms and that the stones got impacted within the CHD, at the level of the arterial crossing. However, if pulsatile compression is an acceptable theory (the right hepatic artery syndrome), then subsequent intrahepatic stone formation should also be regarded as an acceptable one; partial or complete obstruction of the CBD/CHD leads to bile stasis and later on to bacterial proliferation [12].…”

Obstructive jaundice and cholangitis caused by an arterial ring of the proper hepatic artery around the common bile duct

“…In the English literature, Tsuchiya first (1984) described 2 cases of jaundice due to compression by the right hepatic artery [8]. Aneurysm of the hepatic artery can also cause obstructive jaundice [9].…”