Biliary tree anatomy
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View Omar Bashir's current disclosuresAt the time the article was last revised Joachim Feger had no financial relationships to ineligible companies to disclose.
View Joachim Feger's current disclosures- Bile duct
- Bile ducts
- Biliary tree
- Biliary trees
The biliary tree is a branching system of ducts that delivers bile produced in the hepatic parenchyma toward the gallbladder and duodenum.
Gross anatomy
By convention the biliary tree is divided into intra- and extra-hepatic bile ducts 1. There is significant variation in the anatomy of the biliary tree with the classical description below thought to be present in ~60% of the population 2.
Intrahepatic bile ducts
Bile canaliculi unite to form segmental bile ducts which drain each liver segment. The segmental ducts then combine to form sectoral ducts with the following pattern 5:
segments 6 and 7: right posterior sectoral duct (RPSD), coursing more horizontally
segments 5 and 8: right anterior sectoral duct (RASD), coursing more vertically
right posterior and anterior sectoral ducts unite to form the right hepatic duct (RHD)
segmental bile ducts from 2, 3, 4a and 4b unite to form the left hepatic duct (LHD)
The left and right hepatic ducts unite to form the common hepatic duct (CHD). Bile duct(s) from segment 1 (caudate lobe) drain into the angle of this union.
The ducts of the left hepatic lobe are more anterior than those of the right lobe; it is important particularly when contrast cholangiogram is performed because contrast may not opacify non-dependent ducts 3.
Extrahepatic bile ducts
The common hepatic duct is joined by the cystic duct (from the gallbladder) to form the common bile duct 6.
The common bile duct travels initially in the free edge of the lesser omentum, then courses posteriorly to the duodenum and pancreas to unite with the main pancreatic duct to form the ampulla of Vater, which drains at the major duodenal papillae on the medial wall of the D2 segment of the duodenum 6.
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Variant anatomy
Intrahepatic bile ducts
Variant anatomy is quite common 2:
right posterior sectoral duct draining into LHD ~15% (range 13-19%)
right anterior sectoral duct draining into LHD ~6%4
right posterior sectoral duct draining into anterior (not posterior) aspect of right anterior sectoral duct ~12%
"triple confluence": union of RPSD, RASD and LHD to form CHD ~11%
aberrant hepatic duct (typically RPSD draining into CHD) ~6%
low insertion of RHD into CHD ~2%4
accessory hepatic ducts ~2%
Extrahepatic bile ducts
see: cystic duct
Quiz questions
References
- 1. Susan Standring. Gray's Anatomy. (2008) ISBN: 9780443066849 - Google Books
- 2. Mortelé K, Rocha T, Streeter J, Taylor A. Multimodality Imaging of Pancreatic and Biliary Congenital Anomalies. Radiographics. 2006;26(3):715-31. doi:10.1148/rg.263055164 - Pubmed
- 3. William E. Brant, Clyde A. Helms. Fundamentals of Diagnostic Radiology. (2007) ISBN: 9780781761352 - Google Books
- 4. Strasberg, Steven. Hepatic, biliary and pancreatic anatomy. In: James Garden, Rowan W Parks. Hepatobiliary and Pancreatic Surgery E-Book. (2013) ISBN: 9780702049699 - Google Books
- 5. Castaing D. Surgical Anatomy of the Biliary Tract. HPB (Oxford). 2008;10(2):72-6. doi:10.1080/13651820801992518 - Pubmed
- 6. Frances Aitchison. A Guide to Radiological Procedures. (2009) ISBN: 9780702029820 - Google Books
Incoming Links
- Couinaud classification of hepatic segments
- Porta hepatis
- Gallstone disease (summary)
- Hepatolithiasis
- Cholescintigraphy
- Pleurobiliary fistula
- Alveolar echinococcosis
- Secondary sclerosing cholangitis
- Choledocholithiasis
- Intrabiliary rupture of hepatic hydatid cyst
- Magnetic resonance cholangiopancreatography (MRCP)
- Cholangiocarcinoma
- Autoimmune pancreatitis
- Choledochal cyst
- Acute cholangitis
- Haemobilia
- CT cholangiography (protocol)
- Meglumine iotroxate (Biliscopin)
- Portal biliopathy
- Biliary atresia
- Common bile duct stent
- Duplication of common bile duct
- Gallbladder duplication
- Biliary atresia
- Peribiliary cysts
- Cystic duct (ultrasound)
- Biliary duct anatomic variation (diagram)
- Hepatoblastoma
- Low medial cystic duct insertion
- Hepatic pseudolesion due to unrecognized obstruction of right posterior hepatic duct from cholecystectomy
- Cholelithiasis with biliary dilatation
- Cholelithiasis and choledocholithiasis
- Low cystic duct insertion
- Klatskin tumour
- Normal post-cholecystectomy T-tube cholangiogram
- Choledocholithiasis and biliary obstruction
- Biliary tree anatomical variant - biliary trifurcation
- Gallbladder adenocarcinoma
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