Variations of the Anatomical Structure of the Extrahepatic Bile Ducts (Literature Review)

S.A. Dubina, O.K. Zenin


Introduction. The knowledge of anatomy variations and anomalies of development of a biliary tree is one of the most important factors of efficiency of surgical treatment of a biliary stone disease. At the same time, the systematized and non-systematized descriptions of anatomy of separate sites of extrahepatic biliary channels in literature are rather diverse and separate.
Objective of the article is to synthesize the experience of foreign and domestic authors in a question of an assessment of options of a relative positioning of extra hepatic bile ducts.
Main results. Acquaintance with references allows noting that uniform approach to classification of options of anatomy of all extra hepatic biliary tree does not exist. There are different opinions about bile ducts anomalies and variations occurrence frequency. Except a variety of estimates of frequency, in literature there is no unanimity concerning classification of options of occurrence of separate anomalies. Various authors focus attention on separate structures (a structure of the common hepatic duct, a structure of a cystic bile duct, anomaly of pancreatico-biliary maljunction, etc.). Besides, in literature the analysis of clinical cases within a certain classification of anatomic variations or out of that is widely submitted. Systematization and generalization of the specified variations on the basis of the literature review allows make an attempt to build a general classification concerning data of cases of extra hepatic biliary duct anatomy revealed by certain authors,. Its internal structure is determined by allocation of anatomic important areas of extra hepatic bile ducts. The case when the left and right hepatic bile ducts merge, forming the common hepatic duct, further the last, merging with a cystic duct, forms the common bile duct which, in turn, merging with a pancreas duct, forms a hepatopancreatic ampoule in a duodenum wall, is concerned as the most widespread normal option of development of a bile ducts tree.
This classification includes the following groups:
A — anomalies of the left, right and common hepatic ducts (doubling, absence of common hepatic and common bile ducts, intra hepatic and extra hepatic connecting ducts, merge of a right hepatic duct and cystic duct and the subsequent merge of right and left hepatic ducts);
В — variations and anomalies of connection of a cystic duct with common hepatic (high and low maljunction, lack of common hepatic duct (triplet), spiral rounding of common hepatic duct by cystic duct, forming of commissure of cystic and common hepatic ducts);
С — anomalies of development of a cystic duct (a short duct, its absence, doubling, connection with right and left hepatic ducts);
D — aberrant ducts;
E — variations and anomalies of development of common bile duct (a partition in it, bifurcation, a confluence of a common bile duct and small curvature of a stomach);
F — pancreatico-biliary maljunction.
Conclusions. There is no common of approaches concerning variations and anomalies of development of extra hepatic bile ducts and their occurrence in literature. The classification of the variations and anomalies of development of extra hepatic bile ducts is constructed based on literature review. It includes six groups of variations and anomalies: variations and anomalies of connection of a cystic duct with common hepatic duct, anomalies of development of a cystic duct, existence the aberrant ducts (Lushka), anomalies and variations of development of common bile duct and anomaly of pancreatico-biliary maljunction.


biliary tree; extrahepatic bile ducts; variations and anomalies; anatomical structure; classification


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