Variations anatomiques des voies biliaires et conséquences chirurgicales: à propos de 19 cas

Journal Africain d?Hépato-Gastroentérologie 09/2009; 3(3):137-142. DOI: 10.1007/s12157-009-0097-6

ABSTRACT ObjectifsLa connaissance de l’anatomie des voies biliaires et leurs variations sont une condition nécessaire avant toute chirurgie
hépatobiliaire. Le but de ce travail est de faire le point sur les variations anatomiques des voies biliaires et de dégager
leurs incidences chirurgicales.

Matériel et méthodeÉtude rétrospective qui porte sur l’analyse de 70 cholangiographies peropératoire (CPO), nous avons relevé 19 cas de variations
anatomiques chez 16 patients, ce qui représente 27,1 %, trois patients présentaient deux variations.

RésultatsLes variations des canaux droits ont été les plus fréquentes: 11 cas, soit 57,8 % de l’ensemble des cas. Cinq anomalies du
canal cystique, soit 26,3 % et trois anomalies de l’insertion du cholédoque sur le duodénum. Aucune variation n’a intéressé
les canaux biliaires gauches. Ces anomalies ont été responsables de trois accidents peropératoires au cours de la cholécystectomie,
dont une péritonite biliaire et deux fistules biliaires externes.

ConclusionNotre série confirme l’intérêt de la cholangiographie dans l’exploration des voies biliaires afin de détecter des variations
pouvant compliquer l’acte opératoire.

IntroductionBoth intra- and extrahepatic biliary anatomy is complex with the existence of many common and uncommon anatomic variations.
The knowledge of these variations is necessary before biliary and hepatic surgery. Cholangiography peroperative is useful
to evaluate the exact disposition of biliary tract. The aim of this study is to elucidate the anatomic variants of the biliary
tract and there surgical consequences.

Materials and methodsWe retrospectively analysed 70 cholangiography peroperative. We observed 19 anatomic variants of the biliary tree in 16 patients
(27.1%). Three patients had two variations.

ResultsAnatomic variants involved principally the right duct: 11 cases (57.8%). Five variants involved the cystic duct (26.3%) and
three anomalies interested the confluence of choledoque into duodenum. Any variants in the left biliary duct were observed.
These anomalies were associated with three complications: two biliary fistulas and one biliary peritonitis.

ConclusionOur study confirmed the crucial role of the cholangiography peroperative in the detection of anatomic variants in the biliary
tree that may increase the hepatic and biliary surgical complications.

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