Intrahepatic transposition of bile ducts.

Abstract

Objective. To describe the intrahepatic bile duct transposition (anatomical variation occurring in intrahepatic ducts) and to determine the frequency of this variation. Material and Methods. The researches were performed randomly on 100 livers of adults, both sexes. Main research methods were anatomical macrodissection. As a criterion for determination of variations in some parts of bile tree, we used the classification of Segmentatio hepatis according to Couinaud (1957) according to Terminologia Anatomica, Thieme Stuugart: Federative Committee on Anatomical Terminology, 1988. Results. Intrahepatic transposition of bile ducts was found in two cases (2%), out of total examined cases (100): right-left transposition (right segmental bile duct, originating from the segment VIII, joins the left liver duct-ductus hepaticus sinister) and left-right intrahepatic transposition (left segmental bile duct originating from the segment IV ends in right liver duct-ductus hepaticus dexter). Conclusion. Safety and success in liver transplantation to great extent depends on knowledge of anatomy and some common embryological anomalies in bile tree. Variations in bile tree were found in 24-43% of cases, out of which 1-22% are the variations of intrahepatic bile ducts. Therefore, good knowledge on ductal anatomy enables good planning, safe performance of therapeutic and operative procedures, and decreases the risk of intraoperative and postoperative complications.

Full text

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International Scholarly Research Network
ISRN Surgery
Volume 2012, Article ID 283527, 3 pages
doi:10.5402/2012/283527
Research Article
IntrahepaticTransposition of BileDucts
Jasmin Deli´ c,1AdmedinaSavkovi´ c,1EldarIsakovi´ c,1SergijeMarkovi´ c,2
Alma Bajtarevic,3and AmirDenjali´ c3
1Department of Anatomy, Medical Faculty, University Tuzla, 75000 Tuzla, Bosnia and Herzegovina
2Department of Histology and Embriology, Medical Faculty, University Tuzla, 75000 Tuzla, Bosnia and Herzegovina
3Department of Anatomy, Helth Faculty University Zenica, 75000 Tuzla, Bosnia and Herzegovina
Correspondence should be addressed to Jasmin Deli´ c, jasmin.delic@untz.ba
Received 5 January 2012; Accepted 6 February 2012
Academic Editor: B. Ali-El-Dein
Copyright © 2012 Jasmin Deli´ c et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Objective. To describe the intrahepatic bile duct transposition (anatomical variation occurring in intrahepatic ducts) and to
determine the frequency of this variation. Material and Methods. The researches were performed randomly on 100 livers of
adults, both sexes. Main research methods were anatomical macrodissection. As a criterion for determination of variations in
some parts of bile tree, we used the classification of Segmentatio hepatis according to Couinaud (1957) according to Terminologia
Anatomica, Thieme Stuugart: Federative Committee on Anatomical Terminology, 1988. Results. Intrahepatic transposition of
bile ducts was found in two cases (2%), out of total examined cases (100): right-left transposition (right segmental bile duct,
originating from the segment VIII, joins the left liver duct-ductus hepaticus sinister) and left-right intrahepatic transposition (left
segmental bile duct originating from the segment IV ends in right liver duct-ductus hepaticus dexter). Conclusion. Safety and
success in liver transplantation to great extent depends on knowledge of anatomy and some common embryological anomalies in
bile tree. Variations in bile tree were found in 24–43% of cases, out of which 1–22% are the variations of intrahepatic bile ducts.
Therefore, good knowledge on ductal anatomy enables good planning, safe performance of therapeutic and operative procedures,
and decreases the risk of intraoperative and postoperative complications.
1.Introduction
Biliary drainage has long been called Achilles heel liver trans-
plantion, and biliary complications compromise the succese
of liver transplantation [1]. A precise understanding of gen-
eral anatomic principles and common variations is the key
to safe living donor liver transplantation [2]. This procedure
requires not only a precise understanding of liver anatomy
butalsothemeansofassessingthem.Oneofthemostimpor-
tant challenges is that of managing the biliary duct during
liverloberesectionandreimplantation.Olosbiliaryanatomy
variantsareassociatedwithanincreasedriskofpostoperative
complications, including biliary leaks and strictures, in both
the donor and recipient [3, 4]. One cause of complications
is unrecognized anomalous biliary anatomy (24%–57% of
individuals have variant biliary patterns) [5–8]. Although
anomalous anatomy is not alwaysa contraindication for liver
donation, knowledge of variant anatomy is critical to ensur-
ing the safety of donors and aids selection of suitable can-
didates [9, 10].
The authors as Varotti et al., Heloury et al., Soares et al.,
and Cheng et al. noted intrahepatic transposition of bile
ducts in 1 to 22% of cases [10, 11, 13]. Intrahepatic trans-
position of bile ducts is manifested by the fact that bile ducts
originating from the right liver lobe may end in the left liver
duct (ductus hepaticus sinister); that is, bile ducts of the left
liver lobe may end in the right liver duct (ductus hepaticus
dexter).
2.MaterialandMethods
The researches were performed randomly on 100 livers of
adults, both sexes. Main research methods were anatomical
macrodissection and statistics. As a criterion for determi-
nation of variations in some parts of bile tree, we used the
classification Segmentatio hepatis according to Couinaud
(1957) according to Terminologia Anatomica, Thieme Stu-
ugart: Federative Committee on Anatomical Terminology,
1988.

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2ISRN Surgery
Figure 1: Right-left intrahepatic transposition of bile ducts.
3.Results
Aftertheresearcheshavebeencompleted,intrahepatictrans-
position of bile ducts was found in two cases (2%); out of
total examined cases (100) right-left transposition and left-
right intrahepatic transposition were found. In one case we
found right-left intrahepatic transposition, where the right
segmental bile duct (RSBD), originating from the segment
VIII, joins the left liver duct (LLD). Newly evolved duct is
distally united to ductus hepaticus dexter and they form
common liver duct (ductushepaticus communis) (Figure 1).
Inthesecondcase(1%),left-rightintrahepatictransposi-
tion was observed. Left segmental bile duct (LSBD) origi-
nating from the segment IV ends in right liver duct (RLD)
(Figure 2).
4.Discussion
Variability of form, of position in space, and of topographic
relations of bile ducts is immense. Some variations appear
very rarely and in small percentages. On the other hand,
some of the rare variations of bile ducts are in the focus of
surgical anatomy in this area. The key problem in research of
variable anatomy of bile ducts is heterogeneity of the sample,
as well as the case of a small sample. Because of all the cited,
significantdisagreementsarepresentconcerningthefindings
of different researchers in the field of bile ducts anatomy,
what is contributed by lacking of uniformity of methods and
criteria of the research.
Resultsofthisresearchtoagreatextentconfirmtheother
authors’ results presented in the literature available. The
right-lefttranspositionofintrahepaticbileducts,observedin
1%ofcasesinourresearchmaterial,isamorefrequentvaria-
tion and is found, according to the literature available, in
2–22% of cases (bile ducts originating out of segments V,
VI, and VII) [14]. The authors as Jin et al., Heloury et al.,
and Cheng et al. found the left-right transposition in 1–3%
of cases, what corresponds to the results of our researches
[7, 11].
Figure 2: Left-right transposition of intrahepatic bile ducts. Left
segmental bile duct enters right liver duct.
5.Conclusion
Safety and success in liver transplantation to great extent
depends on knowledge of anatomy and some common
embryological anomalies in bile tree. Variations in bile tree
were found in 24–43% of cases, out of which 1–22% are the
variations of intrahepatic bile ducts. Therefore, good knowl-
edge on ductal anatomy enables good planning, safe per-
formance of therapeutic and operative procedures, and
decreases the risk of intraoperative and postoperative com-
plications.
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