Common bile duct
Citation, DOI & article data
In ultrasound imaging, it is not always possible to confidently see where the cystic duct enters the common hepatic duct to form the common bile duct. Therefore it is common practice to use the term common duct (CD) as a term conflating the common hepatic and common bile ducts. Unfortunately, this is in conflict with Gray's Anatomy, which refers to the short duct formed by the union of the common bile and pancreatic ducts as the common duct.
Gross and Ultrasound Anatomy
The CBD is approximately 8 cm long and usually < 6-7 mm wide in internal diameter, in adults. It joins the pancreatic duct at the ampulla of Vater, which drains into the second part of the duodenum through the major duodenal papilla.
Of note, for decades, what had been labeled CBD in much radiology literature is now known actually, usually to have been the CHD. Thus, the oft quoted normal value of < 6 mm (measured inner aspect of wall to inner aspect of wall, typically by ultrasound) in adults actually refers to the CHD in most cases. The CHD is best measured when the patient is fasting, at the porta hepatis, typically parallel and anterior to the portal vein. In recent years, 7 mm has been proposed as a better cut-off by some investigators.
Also for decades, it had been thought that the CHD (then termed the CBD, more often than not erroneously) could increase as much as 4 mm after cholecystectomy, and by age as much as 1 mm per decade after age 60. This has not been supported by subsequent studies, which indicate that the CHD diameter may increase only by 0.1-0.2 mm per decade, and increases only about 1 mm after cholecystectomy.
The diameter of the actual CBD is far more variable, not readily affording a valid cut-off value. By ultrasound, it is seen more inferiorly, usually having exited the porta toward pancreas.
The common bile duct is supplied by a network of arteries from several sources:
- from above: right hepatic artery and cystic artery
- from below: posterior superior pancreaticoduodenal artery, retroduodenal artery, and retroportal artery
There are four main relationships of the CBD with the pancreatic head 2:
- partially covered posteriorly (most common: ~50%)
- completely covered (30%)
- completely uncovered (16.5%)
- CBD may pass laterally to the pancreatic head (least common)
Studies have found that complete separation of the CBD and pancreatic duct with two openings in the duodenum occur in 20% of autopsied specimens and 37% in ERCP studies 6,7. Other authors have reported that overall the finding is rare, with only several cases reported in the literature 8,9.
- 1. Last's anatomy. Churchill Livingstone. ISBN:0443056110. Read it at Google Books - Find it at Amazon
- 2. Mortelé KJ, Rocha TC, Streeter JL et al. Multimodality imaging of pancreatic and biliary congenital anomalies. Radiographics. 2006;26 (3): 715--31. doi:10.1148/rg.263055164 - Pubmed citation
- 3. Standring S, Gray H. Gray's anatomy: The anatomical basis of clinical practice (2008). Edinburgh: Churchill Livingstone/Elsevier
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- 5. Matcuk G, Grant E, Ralls P. Ultrasound Measurements of the Bile Ducts and Gallbladder. Ultrasound Quarterly. 2014;30(1):41-8. doi:10.1097/ruq.0b013e3182a80c98 - Pubmed
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- 7. Misra S, Gulati P, Thorat V, Vij J, Anand B. Pancreaticobiliary Ductal Union in Biliary Diseases. An Endoscopic Retrograde Cholangiopancreatographic Study. Gastroenterology. 1989;96(3):907-12. - Pubmed
- 8. Katsinelos P, Chatzimavroudis G, Fasoulas K et al. Double Major Papilla of Vater - a Rare Endoscopic Finding During Endoscopic Retrograde Cholangiopancreatography: A Case Report. Cases Journal. 2009;2(1):163. doi:10.1186/1757-1626-2-163 - Pubmed
- 9. Chavalitdhamrong D. Unexpected Anomaly of the Common Bile Duct and Pancreatic Duct. WJCC. 2014;2(2):36. doi:10.12998/wjcc.v2.i2.36 - Pubmed