Heterogeneity of Subvesical Ducts or the Ducts of Luschka: A Study Using Drip‐infusion Cholangiography‐Computed Tomography in Patients and Cadaver Specimens

Abstract

The objective of this study was to examine the heterogeneity of the subvesical duct or the ducts of Luschka as well as the reliability of drip-infusion cholangiography with computed tomography (DIC-CT) for their identification. DIC-CT was used in 277 consecutive patients (135 men, 142 women) and for the dissection and histologic study of 10 cadaver livers. We found 32 subvesical ducts in 28 (10.1%) of 277 patients. Irrespective of whether the terminals were extra- or intraparenchymal, the subvesical ducts often (17/32 ducts, 15/28 patients) drained into a subsegmental duct of S5 or S4. Notably, some displayed an "intermediate" course along the gallbladder fossa with an intraparenchymal origin and terminated at S5. Such ducts tended to be seen in the elderly. Another 15 ducts drained into a thick, centrally located duct, such as the right sectorial or hepatic duct. The anatomic study demonstrated that the subvesical duct likely included the cystic vein-concomitant duct. A major type of subvesical duct, characterized by an intermediate course along its bed, appeared to result from degenerative exposure of a peripheral duct with aging. The subvesical duct draining into the thick duct included both a "daughter branch," such as seen in the lung, and the so-called anomaly. Such ducts can be demonstrated with DIC-CT, but the incidence might be limited. However, the cystic vein/concomitant duct was difficult to identify radiologically. Consequently, although presurgical radiology is useful for avoiding bile leakage after laparoscopic cholecystectomy, surgeons should be aware of its limitations.

Bile leaks from the duct of Luschka (subvesical duct): a review

“…Most commonly, they drain into the right hepatic and common hepatic duct. Less frequently, they drain into subsegmental ducts, sectoral ducts, and the left hepatic duct [5,23]. Drainage, therefore, may be in intrahepatic or extrahepatic biliary ducts.…”

“…Kitami et al performed drip-infusion cholangiography with computed tomography (DIC-CT) in 277 patients with cholelithiasis [5]. Subvesical ducts were detected in 28 patients.…”

Temporary Placement of a Newly Designed, Fully Covered, Self-Expandable Metal Stent for Refractory Bile Leaks

“…7 The duct of Luschka mostly drains into the right and common hepatic ducts, and less frequently drains into the subsegmental ducts, sectoral ducts, and left hepatic duct. 8 The amount of bile that extravasates after a subvesical duct injury is variable. If the injured end is connected with the central biliary tree, the volume of extravasated bile may be high.…”

Surgical Management of Segmental and Sectoral Bile Duct Injury After Laparoscopic Cholecystectomy: a Challenging Situation

“…However, MDCT-CA might not be useful in the diagnosis of type 2 SDI because the injured duct drains only a very limited portion of the liver parenchyma that could cause false negative result. 27 Fistulography through a surgically or radiologically placed percutaneous drain in an extrahepatic bile collection has been reported to be effective in the diagnosis by retrograde flow of contrast material into the torn ductal system. 8,9,[12][13][14] The bilioma collection should be mature enough, which takes usually more than 2 weeks, to ensure the contrast material flows toward the source of the bile leakage and not toward other parts of the abdomen.…”

“…[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] A low insertion of a right segmental/sectoral duct into the common bile duct or a short cystic duct, which joins the right biliary system presenting in 3.2% to 36.1% of the population studied, are important variants that place the right duct at risk of being injured. 9,14,[24][25][26][27][28] An unrecognized segmental/ sectoral duct injury (SDI) leads to an intricate postoperative course after LC, most often complicated by bile peritonitis, sepsis, or even secondary vascular complications.…”