Accessory bile duct

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Accessory bile duct
Anatomical terminology

An accessory bile duct is a conduit that transports bile and is considered to be supernumerary or auxiliary to the biliary tree. [1]

Contents

It may be described by its location relative to the gallbladder as supravesicular [2] [3] (superior to the gallbladder body) or subvesicular [4] [5] (inferior to the gallbladder body).

Duct of Luschka

In the surgical literature, the term duct of Luschka is used to refer to an accessory bile duct. They are small ducts that distinctly enter the gallbladder bed, or small tributaries of minor intrahepatic radicals of the right hepatic ductal system. [6] Originating from the hepatic parenchyma the accessory bile duct may enter a large bile duct or the gallbladder at any location. [7] Rarely it is found to be connected directly to the GIT. [8] They may not always drain bile and sometimes can have blind distal ends. [2] One study showed them originating from the liver parenchyma of the right anterior inferior dorsal subsegment or from the connective tissue of the gallbladder bed. The study showed the distal connections ending at the hepatic right anterior inferior dorsal branch, hepatic right anterior branch, right hepatic duct, or common hepatic duct. [4]

The term duct of Luschka is ambiguous, as it may refer to supravesicular [2] [3] or subvesicular ducts. [4] [5] Supravesicular ducts are typically in the gallbladder bed. A 2012 review suggested that the term duct of Luschka should be abandoned because of this ambiguity and replaced by the more specific term subvesical bile duct. [9] As well, the exact origin and drainage locations of the relevant duct(s) varied greatly between patients.

Of 116 articles, 54 provided detailed anatomic information identifying 238 subvesical ducts, most of which represented accessory ducts. The origin and drainage of these ducts were limited primarily to the right lobe of the liver, but great variation was seen.

— -Schnelldorfer et al., [9]

Clinical significance

Although they may not drain any liver parenchyma, they can be a source of a bile leak or biliary peritonitis after cholecystectomy in both adults and children. If an accessory bile duct goes unrecognized at the time of the gallbladder removal, 5–7 days post-operative the patient will develop bile peritonitis, [10] an easily treatable complication with a morbidity rate of 44% if left untreated.

Often diagnosed by HIDA scan, a bile leak from an accessory bile duct post-op can be treated with a temporary biliary stent[ citation needed ] to redirect the bile from the liver into the intestine and allow the accessory duct to spontaneously seal itself or using a drainage guided by radiology. [11]

Eponym

The term is named after German anatomist Hubert von Luschka (1820-1875) [12] [13] who described the first case in 1863. [4]

Related Research Articles

Gallbladder Organ in humans and other vertebrates

In vertebrates, the gallbladder, also known as the cholecyst, is a small hollow organ where bile is stored and concentrated before it is released into the small intestine. In humans, the pear-shaped gallbladder lies beneath the liver, although the structure and position of the gallbladder can vary significantly among animal species. It receives and stores bile, produced by the liver, via the common hepatic duct, and releases it via the common bile duct into the duodenum, where the bile helps in the digestion of fats.

Bile duct Type of organ

A bile duct is any of a number of long tube-like structures that carry bile, and is present in most vertebrates.

Gallstone Disease where stones form in the gallbladder

A gallstone is a stone formed within the gallbladder out of precipitated bile components. The term cholelithiasis may refer to the presence of gallstones or to any disease caused by gallstones, and choledocholithiasis refers to presence of migrated gallstones within bile ducts.

Cholecystitis Medical condition

Cholecystitis is inflammation of the gallbladder. Symptoms include right upper abdominal pain, pain in the right shoulder, nausea, vomiting, and occasionally fever. Often gallbladder attacks precede acute cholecystitis. The pain lasts longer in cholecystitis than in a typical gallbladder attack. Without appropriate treatment, recurrent episodes of cholecystitis are common. Complications of acute cholecystitis include gallstone pancreatitis, common bile duct stones, or inflammation of the common bile duct.

Cholecystectomy Surgical removal of the gallbladder

Cholecystectomy is the surgical removal of the gallbladder. Cholecystectomy is a common treatment of symptomatic gallstones and other gallbladder conditions. In 2011, cholecystectomy was the eighth most common operating room procedure performed in hospitals in the United States. Cholecystectomy can be performed either laparoscopically, or via an open surgical technique.

Common bile duct Gastrointestinal duct

The common bile duct, sometimes abbreviated as CBD, is a duct in the gastrointestinal tract of organisms that have a gallbladder. It is formed by the confluence of the common hepatic duct and cystic duct and terminates by uniting with pancreatic duct, forming the ampulla of Vater. The flow of bile from the ampulla of Vater into the duodenum is under the control of the sphincter of Oddi.

Pancreaticoduodenectomy

A pancreaticoduodenectomy, also known as a Whipple procedure, is a major surgical operation most often performed to remove cancerous tumours from the head of the pancreas. It is also used for the treatment of pancreatic or duodenal trauma, or chronic pancreatitis. Due to the shared blood supply of organs in the proximal gastrointestinal system, surgical removal of the head of the pancreas also necessitates removal of the duodenum, proximal jejunum, gallbladder, and, occasionally, part of the stomach.

Common bile duct stone Medical condition

Common bile duct stone, also known as choledocholithiasis, is the presence of gallstones in the common bile duct (CBD). This condition can cause jaundice and liver cell damage. Treatments include choledocholithotomy and endoscopic retrograde cholangiopancreatography (ERCP).

Common hepatic duct Exocrine duct

The common hepatic duct is the first part of the biliary tract. It joins the cystic duct coming from the gallbladder to form the common bile duct.

Gallbladder cancer Medical condition

Gallbladder cancer is a relatively uncommon cancer, with an incidence of fewer than 2 cases per 100,000 people per year in the United States. It is particularly common in central and South America, central and eastern Europe, Japan and northern India; it is also common in certain ethnic groups e.g. Native American Indians and Hispanics. If it is diagnosed early enough, it can be cured by removing the gallbladder, part of the liver and associated lymph nodes. Most often it is found after symptoms such as abdominal pain, jaundice and vomiting occur, and it has spread to other organs such as the liver.

Cystic artery

The cystic artery supplies oxygenated blood to the gallbladder and cystic duct.

Biliary fistula Medical condition

A biliary fistula is a type of fistula in which bile flows along an abnormal connection from the bile ducts into nearby hollow structure. Types of biliary fistula include:

Ascending cholangitis Medical condition

Ascending cholangitis, also known as acute cholangitis or simply cholangitis, is inflammation of the bile duct (cholangitis), usually caused by bacteria ascending from its junction with the duodenum. It tends to occur if the bile duct is already partially obstructed by gallstones.

Cystohepatic triangle Space between the cystic duct, the common hepatic duct, and the liver

The cystohepatic triangle is an anatomic space bordered by the cystic duct inferiorly, the common hepatic duct medially, and the inferior surface of the liver superiorly. The cystic artery lies within the hepatobiliary triangle, which is used to locate it during a laparoscopic cholecystectomy.

Biliary colic Medical condition in which gallstones cause acute pain

Biliary colic, also known as symptomatic cholelithiasis, a gallbladder attack or gallstone attack, is when a colic occurs due to a gallstone temporarily blocking the cystic duct. Typically, the pain is in the right upper part of the abdomen, and can be severe. Pain usually lasts from 15 minutes to a few hours. Often, it occurs after eating a heavy meal, or during the night. Repeated attacks are common.

Percutaneous transhepatic cholangiography

Percutaneous transhepatic cholangiography, percutaneous hepatic cholangiogram (PTHC) is a radiological technique used to visualize the anatomy of the biliary tract. A contrast medium is injected into a bile duct in the liver, after which X-rays are taken. It allows access to the biliary tree in cases where endoscopic retrograde cholangiopancreatography has been unsuccessful. Initially reported in 1937, the procedure became popular in 1952.

Biliary dyskinesia is a disorder of some component of biliary part of the digestive system in which bile cannot physically move in the proper direction through the tubular biliary tract. It most commonly involves abnormal biliary tract peristalsis muscular coordination within the gallbladder in response to dietary stimulation of that organ to squirt the liquid bile through the common bile duct into the duodenum. Ineffective peristaltic contraction of that structure produces postprandial right upper abdominal pain (cholecystodynia) and almost no other problem. When the dyskinesia is localized at the biliary outlet into the duodenum just as increased tonus of that outlet sphincter of Oddi, the backed-up bile can cause pancreatic injury with abdominal pain more toward the upper left side. In general, biliary dyskinesia is the disturbance in the coordination of peristaltic contraction of the biliary ducts, and/or reduction in the speed of emptying of the biliary tree into the duodenum.

Biliary injury is the traumatic damage of the bile ducts. It is most commonly an iatrogenic complication of cholecystectomy, but can also be caused by other operations or by major trauma. The risk of biliary injury is more during laparoscopic cholecystectomy than during open cholecystectomy. Biliary injury may lead to several complications and may even cause death if not diagnosed in time and managed properly. Ideally biliary injury should be managed at a center with facilities and expertise in endoscopy, radiology and surgery.

Sphincter of Oddi dysfunction Medical condition

Sphincter of Oddi dysfunction refers to a group of functional disorders leading to abdominal pain due to dysfunction of the Sphincter of Oddi: functional biliary sphincter of Oddi and functional pancreatic sphincter of Oddi disorder. The sphincter of Oddi is a sphincter muscle, a circular band of muscle at the bottom of the biliary tree which controls the flow of pancreatic juices and bile into the second part of the duodenum. The pathogenesis of this condition is recognized to encompass stenosis or dyskinesia of the sphincter of Oddi ; consequently the terms biliary dyskinesia, papillary stenosis, and postcholecystectomy syndrome have all been used to describe this condition. Both stenosis and dyskinesia can obstruct flow through the sphincter of Oddi and can therefore cause retention of bile in the biliary tree and pancreatic juice in the pancreatic duct.

Biloma is collection of bile within the abdominal cavity. It happens when there is a bile leak, for example after surgery for removing the gallbladder, with an incidence of 0.3–2%. Other causes are biliary surgery, liver biopsy, abdominal trauma, and, rarely, spontaneous perforation.

References

  1. ↑ Strasberg, Steven M.; Hawkins, William (2006). "Reconstruction of the Bile Duct: Anatomic Principles and Surgical Techniques". In Fischer, Josef E.; Bland, Kirby I.; Caller, Mark P. (eds.). Mastery of Surgery. Lippincott Williams & Wilkins. pp. 1129–42. ISBN   978-0-7817-7165-8.
  2. 1 2 3 Sharif, K; De Ville De Goyet, J (2003). "Bile duct of luschka leading to bile leak after cholecystectomy—revisiting the biliary anatomy". Journal of Pediatric Surgery. 38 (11): E21–3. doi:10.1016/j.jpedsurg.2003.08.008. PMID   14614740.
  3. 1 2 McQuillan, T.; Manolas, S. G.; Hayman, J. A.; Kune, G. A. (1989). "Surgical significance of the bile duct of Luschka". British Journal of Surgery. 76 (7): 696–8. doi:10.1002/bjs.1800760715. PMID   2765803. S2CID   34673519.
  4. 1 2 3 4 Ko, Kenju; Kamiya, Junichi; Nagino, Masato; Oda, Koji; Yuasa, Norihiro; Arai, Toshiyuki; Nishio, Hideki; Nimura, Yuji (2006). "A Study of the Subvesical Bile Duct (Duct of Luschka) in Resected Liver Specimens". World Journal of Surgery. 30 (7): 1316–20. doi:10.1007/s00268-005-0469-z. PMID   16830216. S2CID   8912905.
  5. 1 2 Spanos, Constantine P.; Syrakos, Theodore (2006). "Bile leaks from the duct of Luschka (subvesical duct): A review". Langenbeck's Archives of Surgery. 391 (5): 441–7. doi:10.1007/s00423-006-0078-9. PMID   16927110. S2CID   19546499.
  6. ↑ "UpToDate". www.uptodate.com.
  7. ↑ Balija, M; Huis, M; Szerda, F; Bubnjar, J; Stulhofer, M (2003). "[Laparoscopic cholecystectomy--accessory bile ducts]". Acta Medica Croatica (in Croatian). 57 (2): 105–9. ISSN   1330-0164. PMID   12879689.
  8. ↑ Lee, Jei Hee; Yu, Jeong-Sik; Park, Mi-Suk; Yoon, Dong Sup; Yang, Seok Woo (2007). "MR Cholangiography of Accessory Bile Duct Connected to the Stomach". American Journal of Roentgenology. American Roentgen Ray Society. 189 (6): W344–W347. doi:10.2214/ajr.05.1570. ISSN   0361-803X. PMID   18029847.
  9. 1 2 Schnelldorfer, Thomas; Sarr, Michael G.; Adams, David B. (2012). "What is the Duct of Luschka?—A Systematic Review". Journal of Gastrointestinal Surgery. 16 (3): 656–62. doi:10.1007/s11605-011-1802-5. PMID   22215244. S2CID   307073.
  10. ↑ Balija, M; Huis, M; Szerda, F; Bubnjar, J; Stulhofer, M (2003). "[Laparoscopic cholecystectomy--accessory bile ducts]". Acta Med Croatica. 57 (2): 105–9. PMID   12879689.
  11. ↑ Pineño-Flores, Cristina; Segura-Sampedro, Juan José; García-Pérez, José María; Soldevila-García, Carla; Palma-Zamora, Elías; González-Argenté, Francesc Xavier (2017-04-17). "Subvesical duct injury resolved by percutaneous drainage". Gastroenterologia y Hepatologia. 41 (3): 172–174. doi:10.1016/j.gastrohep.2017.03.005. ISSN   0210-5705. PMID   28427730.
  12. ↑ Bátorfi, J; Baranyay, F; Simon, E; Beznicza, H; Kolonics, G (2004). "Luschka-jarati epecsorgas laparoszkopos ellatasa laparoszkopos cholecystectomia utan" [Laparoscopic treatment of bile leakage from the Luschka duct after laparoscopic cholecystectomy]. Orvosi Hetilap (in Hungarian). 145 (20): 1061–4. PMID   15202328.
  13. ↑ Luschka's ducts at Who Named It?
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