The anatomy of the cystic duct and its association with cholelithiasis: <scp>MR</scp> cholangiopancreatographic study

Anatomical variations of the intra- and extra-hepatic biliary system are common, including those affecting the course and insertion point of the cystic duct. Adequate knowledge of such variations and an appropriate roadmap before any surgical, endoscopic or percutaneous procedure help in preventing associated iatrogenic complications. Magnetic resonance cholangiopancreatography (MRCP) can precisely delineate the anatomy of the biliary system preoperatively. We report the case of a 72-year-old female patient who presented with chronic right upper quadrant abdominal pain of 6 months duration, which had acutely worsened over the previous 2 weeks, and no other comorbidities. Blood tests were normal. Abdominal ultrasound revealed a slight dilatation of the common hepatic duct (10 mm) but no gallstones or sludge were demonstrated. MRCP excluded choledocholithiasis but revealed a cystic duct coursing medial to the common bile duct before anastomosing at the level of the ampulla of Vater. Trifurcation (Type 2 variant) of the intra-hepatic bile system was also observed. To the best of the Authors’ knowledge, this is the very first report of this exceptionally rare anatomic cystic duct anomaly on MRCP.

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Classification of anatomical morphology of cystic duct and its association with gallstone

Zhu,

Zhao,

Kang

et al. 2024

World J Gastrointest Surg

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BACKGROUND Gallstones are common lesions that often require surgical intervention. Laparoscopic cholecystectomy is the treatment of choice for symptomatic gallstones. Preoperatively, the anatomical morphology of the cystic duct (CD), needs to be accurately recognized, especially when anatomical variations occur in the CD, which is otherwise prone to bile duct injury. However, at present, there is no optimal classification system for CD morphology applicable in clinical practice, and the relationship between anatomical variations in CDs and gallstones remains to be explored. AIM To create a more comprehensive clinically applicable classification of the morphology of CD and to explore the correlations between anatomic variants of CD and gallstones. METHODS A total of 300 patients were retrospectively enrolled from October 2021 to January 2022. The patients were divided into two groups: The gallstone group and the nongallstone group. Relevant clinical data and anatomical data of the CD based on magnetic resonance cholangiopancreatography (MRCP) were collected and analyzed to propose a morphological classification system of the CD and to explore its relationship with gallstones. Multivariate analysis was performed using logistic regression analyses to identify the independent risk factors using variables that were significant in the univariate analysis. RESULTS Of the 300 patients enrolled in this study, 200 (66.7%) had gallstones. The mean age was 48.10 ± 13.30 years, 142 (47.3%) were male, and 158 (52.7%) were female. A total of 55.7% of the patients had a body mass index (BMI) ≥ 24 kg/m2. Based on the MRCP, the CD anatomical typology is divided into four types: Type I: Linear, type II: n-shaped, type III: S-shaped, and type IV: W-shaped. Univariate analysis revealed differences between the gallstone and nongallstone groups in relation to sex, BMI, cholesterol, triglycerides, morphology of CD, site of CD insertion into the extrahepatic bile duct, length of CD, and angle between the common hepatic duct and CD. According to the multivariate analysis, female, BMI (≥ 24 kg/m2), and CD morphology [n-shaped: Odds ratio (OR) = 10.97, 95% confidence interval (95%CI): 5.22-23.07, P < 0.001; S-shaped: OR = 4.43, 95%CI: 1.64-11.95, P = 0.003; W-shaped: OR = 7.74, 95%CI: 1.88-31.78, P = 0.005] were significantly associated with gallstones. CONCLUSION The present study details the morphological variation in the CD and confirms that CD tortuosity is an independent risk factor for gallstones.

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The anatomy of the cystic duct and its association with cholelithiasis: MR cholangiopancreatographic study

Cited by 3 publications

References 21 publications

Current Status of Diagnosis and Treatment of Acute Calculous Cholecystiti

Current Status of Diagnosis and Treatment of Acute Calculous Cholecystiti

An exceedingly rare case of separated drainage of the cystic duct, the common bile duct and the main pancreatic duct documented on magnetic resonance cholangiopancreatography

Classification of anatomical morphology of cystic duct and its association with gallstone

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