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Trifurcated hepatic duct with low union complicated by choledocholithiasis.
| Content Provider | Semantic Scholar |
|---|---|
| Author | Yang, Jiamei Kim, Karl H. S. Kim, Tae Nyeun |
| Copyright Year | 2013 |
| Abstract | A 74-year-old man was admitted to our hospital with right upper quadrant pain. Laboratory data on admission were as follows: aspartate transaminase (AST) 26 IU/ L, alanine transaminase (ALT) 70IU/L, total bilirubin 0.9mg/dL, alkaline phosphatase 337U/L, and γ-glutamyl transpeptidase 552U/L. Magnetic resonance cholangiopancreatography (MRCP) revealed a trifurcated configuration of hepatic ducts with an unusual low union, and drainage of the cystic duct into the right posterior segmental duct, accompanied by several common bile duct (CBD) stones (●" Fig.1). Endoscopic retrograde cholangiopancreatography (ERCP) revealed similar findings to those of theMRCP. The CBD stoneswere removed successfully using a retrieval basket after endoscopic sphincterotomy (●" Fig.2). After 4 days, the patient underwent cholecystectomy followed by hepaticojejunostomy. To the best of our knowledge, this unusual anomaly has not been described previously. This case is of clinical significance because such an anomaly could lead to accidental dissection or ligation of the bile ductduring laparoscopic cholecystectomy. Triple confluence of the right anterior and posterior segmental ducts and the left hepatic duct isknown tooccur inup to10%of hepatic duct variations [1]. Drainage of the cystic duct directly into the right hepatic duct at a low level is quite rare [2]. The pattern of variation in some hepatic ducts may eventually lead to impaired bile flow and bile stasis, subsequently resulting in bacterial overgrowth and formation of primary bile duct stones. Any ligation or dissection of the hepatic duct will result in potentially fatal complications, such as bile leakage, partial biliary obstruction, ductal stricture, cholangitis, or biliary cirrhosis [3–5]. In order to avoid serious iatrogenic injuries of the bile duct, thorough interpretation and accurate diagnosis of any anatomical variation of the biliary tree is emphasized. |
| Starting Page | E74 |
| Ending Page | E74 |
| Page Count | 1 |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | https://www.thieme-connect.com/products/ejournals/pdf/10.1055/s-0032-1326107.pdf |
| PubMed reference number | 23526526v1 |
| Alternate Webpage(s) | https://doi.org/10.1055/s-0032-1326107 |
| DOI | 10.1055/s-0032-1326107 |
| Journal | Endoscopy |
| Volume Number | 45 |
| Language | English |
| Access Restriction | Open |
| Subject Keyword | Alanine Transaminase Alkaline Phosphatase Aspartic Acid Bile Duct Diseases Bile duct carcinoma Bile fluid Biliary cirrhosis Biliary tract obstruction Biliary tract structure Bilirubin Calculi Cholangiopancreatography, Magnetic Resonance Cholangitis Cholecystectomy procedure Cholecystectomy, Laparoscopic Choledocholithiasis Cholestasis Common bile duct structure Cystic duct structure Duct (organ) structure Ductal Breast Carcinoma In Situ and Lobular Carcinoma In Situ Endoscopic Retrograde Cholangiopancreatography Extravasation Fibrosis Hospital admission Ligation Pain Patients Peptidyltransferase SGOT - Glutamate oxaloacetate transaminase Sphincterotomy, Endoscopic Stenosis Structure of left hepatic duct Structure of right hepatic duct Transaminases hepatojejunostomy stasis |
| Content Type | Text |
| Resource Type | Article |
