A study of the anatomic variations of the pancreatico-biliary system in Palestine: a national study
DOI:
https://doi.org/10.18203/2349-2902.isj20191066Keywords:
Pancreatic-biliary system, Anatomical variations, MRCPs, PalestineAbstract
Background: The objective of this study is to assess the frequency of anatomic variations of the biliary system in the Palestinian population in patients undergoing MRCPs.
Methods: For a period of 3 years, from March 2016 to January 2019, a total of 401 MRCPS were performed in different Palestinian Medical Centers for different indications. 346 Images were included in the study. Images were evaluated independently by two expert radiologists for the presence of variations in the anatomy of gallbladder, cystic duct, common bile duct, pancreatic duct, pancreas and intrahepatic ducts.
Results: About 78% of the images had normal anatomy of Intra-hepatic ducts. Right posterior duct joining the right anterior duct by its lateral side was observed in 12.6% of images and triple confluence in 8.5% of images. About 12% of the gallbladder images have anatomical variation; multi-septate in 4.1% of images and ectopic in 3.7% images. For the cystic duct, it was abnormally low in 9.6% of images and high in 5.3% of images. The cystic duct was found parallel in 2.3% of images. Variations of the pancreatic duct were evident in 3.9% of the images.
Conclusions: anatomical variations of the pancreatico-biliary system are common and they are worth the attention to prevent major complications during hepatobiliary surgeries.
Metrics
References
Adams DB. The importance of extrahepatic biliary anatomy in preventing complications at laparoscopic cholecystectomy. Surg Clin North Am. 1993;73(4):861-71.
Griffin N, Charles-Edwards G, Grant LA. Magnetic resonance cholangiopancreatography: the ABC of MRCP. Insights into imaging, 2011;3(1):11-21.
Cachoeira E, Rivas A, Gabrielli C. Anatomic variations of extrahepatic bile ducts and evaluation of the length of ducts composing the cystohepatic triangle. Int J Morphol. 2012;30:279-83.
Ressurreição J, Batista L, Soares JT, Marques I, Matos E, Andrade L, et al. Normal anatomy and anatomic variants of the biliary tree and pancreatic ductal system at MRCP - what the clinicians want to know. European Soc Radiol. 2014: 1-38.
De Filippo M, Calabrese M, Quinto S, Rastelli A, Bertellini A, Martora R, et al. Congenital anomalies and variations of the bile and pancreatic ducts: magnetic resonance cholangiopancre-atography findings, epidemiology and clinical significance. Radiol Med. 2008;113(6):841-59.
Nagral S. Anatomy relevant to cholecystectomy. J Minimal Access Surg. 2005;1(2):53-8.
Mortelé KJ, Ros PR. Anatomic Variants of the Biliary Tree. Am J Roentgenol. 2001;177(2):389-94.
Rajguru J, Khare S, Jain S, Ghai R, Singla M, Goel, P, et al. Variations in the External Morphology of Gall Bladder. Elsevier. 2012;61:9–12.
Song GW, Lee SG, Hwang S, Sung GB, Park KM, Kim KH, et al. Preoperative evaluation of biliary anatomy of donor in living donor liver transplantation by conventional nonenhanced magnetic resonance cholangiography. Transpl Int, 2007;20(2):167-73.
Mortele KJ, Rocha TC, Streeter JL, Taylor AJ. Multimodality imaging of pancreatic and biliary congenital anomalies. Radiographics. 2006;26(3):715-31.
Ando H. Embryology of the biliary tract. Dig Surg. 2010;27(2):87-9.
Roskams T, Desmet V. Embryology of extra- and intrahepatic bile ducts, the ductal plate. Anat Rec (Hoboken). 2008;291(6):628-35.
Sureka B, Bansal K, Patidar Y, Arora A. Magnetic resonance cholangiographic evaluation of intrahepatic and extrahepatic bile duct variations. Indian J Radiol Imaging. 2016;26(1):22-32.
Taourel P, Bret PM, Reinhold C, Barkun AN, Atri M. Anatomic variants of the biliary tree:diagnosis with MR cholangiopancreatography. Radiology. 1996;199(2):521-7.
Deka P, Islam M, Jindal D, Kumar N, Arora A, Negi SS. Analysis of biliary anatomy according to different classification systems. Indian J Gastroenterol. 2014;33(1):23-30.
Hossary SH, Zytoon AA, Eid M, Hamed A, Sharaan M, Ebrahim AA. MR cholangiopancreatography of the pancreas and biliary system:a review of the current applications. Curr Probl Diagn Radiol. 2014;43(1):1-13.
Andriulli A, Loperfido S, Napolitano G, Niro G, Valvano MR, Spirito F, et al. Incidence Rates of Post-ERCP Complications: A Systematic Survey of Prospective Studies. Am J Gastroenterol. 2007;102:1781-8.
Sarawagi, R, Sundar S, Gupta SK, Raghuwanshi S. Anatomical Variations of Cystic Ducts in Magnetic Resonance Cholangiopancreatography and Clinical Implications. J Radiol Resd Pract. 2016;2016:3021484:6.
Lyu SY, Pan KT, Chu SY, Hsu MY, Chen CM, Hung CF, et al. Common and rare variants of the biliary tree:Magnetic resonance cholangiographic findings and clinical implications. J Radiol Sci. 2012;37:59-67.
Talpur KA, Laghari AA, Yousfani SA, Malik AM, Memon AI, Khan SA. Anatomical variations and congenital anomalies of extra hepatic biliary system encountered during laparoscopic cholecystectomy. J Pak Med Assoc. 2010;60(2):89-93.
Tsitouridis I, Lazaraki G, Papastergiou C, Pagalos E, Germanidis G. Low conjunction of the cystic duct with the common bile duct:does it correlate with the formation of common bile duct stones? Surg Endosc. 2007;21(1):48-52.
Mortele KJ, Ros PR. Anatomic variants of the biliary tree:MR cholangiographic findings and clinical applications. AJR Am J Roentgenol. 2001;177(2):389-94.
Nigam GL, Lalwani R, Ramesh Babu CS, Chauhan C. Surgical anatomy of sub-hepatic biliary system. J Anatomical Soc India. 2014;63(1):48-51.
Nadeem G. A Study of the Clinico-Anatomical Variations in the Shape and Size of Gallbladder. J Morphological Sci. 2016;33:62-7.
Blumberg NA. Transverse septum of the gallbladder. S Afr J Surg. 1981;19(2):139-43.
Spech HJ, Hummer N, Braun H. Septate gallbladder (author's transl). Med Klin. 1975;70(21):941-6.
Adibelli ZH, Adatepe M, Imamoglu C, Esen OS, Erkan N, Yildirim M. Anatomic variations of the pancreatic duct and their relevance with the Cambridge classification system:MRCP findings of 1158 consecutive patients. Radiol Oncol. 2016;50(4):370-7.
Kim HJ, Kim MH, Lee SK, Seo DW, Kim YT, Lee DK, et al. Normal structure, variations, and anomalies of the pancreaticobiliary ducts of Koreans:a nationwide cooperative prospective study. Gastrointest Endosc. 2002;55(7):889-96.
Castaing D. Surgical anatomy of the biliary tract. HPB : the official journal of the International Hepato Pancreato Biliary Association. 2008;10(2):72-6.
Taghavi SA, Niknam R, Alavi SE, Ejtehadi F, Sivandzadeh GR, Eshraghian A. Anatomical Variations of the Biliary Tree Found with Endoscopic Retrograde Cholagiopancreatography in a Referral Center in Southern Iran. Middle East J Digest Dis. 2017;9(4):201-5.
Al-Jiffry B. Anatomic variations of intra- and extra-hepatic biliary system in the Kingdom of Saudi Arabia. 2015;4(3):147-50.
Uysal F, Obuz F, Uçar A, Seçil M, Igci E, Dicle O. Anatomic Variations of the Intrahepatic Bile Ducts: Analysis of Magnetic Resonance Cholangio-pancreatography in 1,011 Consecutive Patients. 2014;89:194-200.