Biliary anatomy and pancreatic duct variations: A cross-sectional study
Murad Aljiffry1, Mohammad Abbas1, Mohammad A. M. Wazzan2, Ahmed H Abduljabbar2, Safiyah Aloufi2, Emad Aljahdli3
1 Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
2 Department of Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
3 Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
Division of Hepatopancreaticobiliary Surgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, P.O. Box 80215, Jeddah 21589
Source of Support: None, Conflict of Interest: None
Background/Aim: Biliary tree and pancreatic duct can appear in different variations whose proper understanding is obligatory for surgeons. Magnetic resonance cholangiopancreatography (MRCP) is considered a safe and accurate tool for evaluating biliary tree and pancreatic duct. Typical anatomy for right hepatic duct (RHD) and left hepatic duct (LHD) is reported as 57% and 63%, respectively. The most common (4-10%) pancreatic anomaly is divisum. In the present study, we evaluated and determined the prevalence of biliary tree and pancreatic duct variations among patients at a university hospital.
Materials and Methods: The MRCP records of 370 patients from 2015 to 2017 were obtained for cross-sectional study. Images were retrospectively reviewed for variations by two independent senior radiologists. Demographic data were obtained for all the patients. Huang et al. classification was used for RHD and LHD variations. The cystic duct was reported based on its course and insertion pattern. The pancreatic duct was observed for the presence of divisum, its course, and configuration.
Results: Three hundred and twenty-five patients were included in the final study. Most commonly observed variant for RHD were A1 (34.2%) and A2 (32.2%). For LHD, B1 (71.4%) was the most common variant. Cystic duct insertion was commonly seen as right lateral insertion (27.7%). Pancreatic divisum was observed in 0.6% of cases. Nationality, origin, and gender-specific variations were obtained.
Conclusion: Variations in biliary anatomy and pancreatic duct are very diverse and extend from the intrahepatic biliary system down to the pancreas. Performing a similar study on a larger population is mandatory to illustrate the range of variations present within the community.