Aberrant bile duct communicating with the cystic duct: From early detection to management of late surgical complications
Phonthep Angsuwatcharakon a , b , Pradermchai Kongkam b , Wiriyaporn Ridtitid b , Panida Piyachaturawat b , Phuphat Vongwattanakit c , Prooksa Ananchuensook b , Natee Faknak b , Kunvadee Vanduangden b , Rungsun Rerknimitr b , d , ∗
a Department of Anatomy, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
b Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok,
Thailand
c Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
d Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
∗ Corresponding author at: Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
E-mail address: ercp@live.com (R. Rerknimitr) .
Abstract：The aberrant hepatic duct is classified by Huang et al. [1] into type A (right intrahepatic duct variant) and type B (left intrahepatic duct variant). Type A and B are further classified into 5 (A1- 5) and 6 (B1-6) subtypes, respectively. The variation of cystic duct involves only in type A. Type A1 or classic arrangement refers to the formation of the common hepatic duct (CHD) by the left hepatic duct (LHD) and the right hepatic duct (RHD). The RHD has two tributaries composed of the right anterior hepatic duct (RAHD) and the right posterior hepatic duct (RPHD). Then, the common bile duct (CBD) is formed when the cystic duct joins with the CHD ( Fig. 1 ). Type A2 refers to the RAHD and RPHD joining with LHD at hepatic hilum, and the absence of the RHD. Type A3 refers to the RAHD or RPHD directly draining to the LHD. Type A4 refers to the RAHD or RPHD directly draining to the CHD. Type A5 refers to the RAHD, RPHD or RHD directly draining to the cystic duct (or aberrant bile duct communicating with the cystic duct, ACC) ( Fig. 1 ) [1] . A recent systematic review including 17 045 subjects reported the global prevalence of type A1-5 being 62.6%, 11.5%, 11.5%, 6.4%, and 0.58%, respectively [2] . Unrecognized type A5 could lead to complications after cholecystectomy, especially bile leakage or stricture. Preoperative cholangiograms, either by magnetic resonance cholangiography (MRC), endoscopic retrograde cholangiography (ERC) or intraoperative cholangiogram (IOC), could be helpful to detect this variation. However, these cholangiograms are not routinely done. Therefore, this variation is usually suspected after the development of postoperative complications. Herein, we present five cases of ACC which include two preoperative cases and three postoperative cases.
引用本文:
. [J]. Hepatobiliary Pancreat Dis Int, 2024, 23(4): 412-416.
Angsuwatcharakon P, Kongkam P, Ridtitid W, Piyachaturawat P, Vongwattanakit P, Ananchuensook P, Faknak N, Vanduangden K, Rerknimitr R. Aberrant bile duct communicating with the cystic duct: From early detection to management of late surgical complications. Hepatobiliary Pancreat Dis Int, 2024, 23(4): 412-416.
2024, Vol. 23 
