IJAR.2022.160

Type of Article:  Original Research

Volume 10; Issue 3 (September 2022)

Page No.: 8391-8397

DOI: https://dx.doi.org/10.16965/ijar.2022.160

Anatomical Variations of Cystic Ducts in Magnetic Resonance Cholangiopancreatography: A Retrospective Study With 265 Patients

Sushant Agarwal 1, Pradipta Ray Choudhury 2, Krishna Kanta Biswas 3, Prabahita Baruah *4, Abhamoni Baro 5.

1 Assistant Professor, Department of Radiology, Gauhati Medical College and Hospital, Guwahati, Assam, India.

2 Assistant Professor, Department of Anatomy, Silchar Medical College and Hospital, Silchar, Assam, India.

3 Demonstrator, Department of Anatomy, Silchar Medical College and Hospital, Assam, India.

*4 Assistant Professor, Department of Anatomy, Silchar Medical College and Hospital, Silchar, Assam, India.

5Assistant Professor, Department of Endocrinology, Gauhati Medical College and Hospital, Guwahati, Assam, India.

Corresponding Author: Dr. Prabahita Baruah, Assistant Professor, Department of Anatomy, Silchar Medical College and Hospital, Silchar, Assam, India. E-Mail: prabahitabaruah@gmail.com

ABSTRACT

Background: Anatomical variations of cystic duct (CD) are frequently unrecognized. It is important to be aware of these variations prior to any surgical, percutaneous, or endoscopic intervention procedures.

Objectives: The purpose of our study was to demonstrate the imaging features of cystic duct and its variants using magnetic resonance cholangiopancreatography (MRCP) and document their prevalence in our population.

Materials and Methods: This study included 265 patients who underwent magnetic resonance cholangiopancreatography due to different indications and variations of cystic duct were documented.

Results: Normal lateral insertion of cystic duct at middle third of common hepatic duct was seen in 29.43% of cases. Medial insertion was seen in 2.63% of cases, 2.26% were low medial insertions. Low insertion of cystic duct was noted in 1.51 % of cases. Parallel course of cystic duct was present in 0.38% of cases. High insertion was noted in 0.38% cases and no case of short cystic duct was noted. No case of cystic duct draining into right hepatic duct was seen. Conclusion: Cystic duct variations are common and MRCP is an optimal imaging modality for demonstration of cystic duct anatomy.

Key words: Cystic Duct, Hepatic Duct, Variation, MRCP.

REFERENCES

[1]. Standring S. Abdomen and pelvis. In: Stringer MD, Smith AL, Wein AJ. [ed] Gray’s Anatomy The anatomical basis of clinical practice. 41st ed. Elsevier Churchill Livingstone. Edinburg, 2016:1174.
[2]. Turner MA and Fulcher AS. The cystic duct: normal anatomy and disease processes, RadioGraphics. 2001; 21(1):3–22.
[3]. Rodrigues G, Pandit SR, Khan A, Veerabharappa B, Jayasankar B and Anaparti R. High insertion of cystic duct at the gallbladder fundus: an undescribed anomaly. J Minim Access Surg. 2019; 15(3): 256–58.
[4]. Wu YH, Liu ZS, Mrikhi R, Ai ZL, Sun Q, Bangoura G et al. Anatomical variations of the cystic duct: two case reports. World Journal of Gastroenterology 2008; 14 (1):155–57.
[5]. Fujikawa T, Takeda H, Matsusue S, Nakamura Y, Nishimura S. Anomalous duplicated cystic duct as a surgical hazard: report of a case. Surgery Today 1998;28(3):313– 15.
[6]. Hassan AU, Zargar SA, Malik A, Shah P. Surgical significance of variations in anatomy in the biliary region. J Minim Access Surg. 15(3): 256-58.
[7]. Sarawagi R, Sundar S, Gupta SK, Raghuwanshi S. Anatomical variations of cystic ducts in Magnetic Resonance Cholangiopancreatography and clinical implications. Radiol Res Pract. 2016(2):1-6.
[8]. Hashimoto M, Hashimoto M, Ishikawa T, Iizuka T, Matsuda M, and Watanabe G. Right hepatic duct emptying into the cystic duct: report of a case. Surgical Endoscopy; 16(2):359.
[9]. Cachoeira E. Anatomic variations of extrahepatic bile ducts and evaluation of the length of ducts composing the cystohepatic triangle. International Journal of Morphology. 2012; 30(1):279-83.
[10]. Ashalatha PR, Jayasree K. Anomalies of Gall Bladder And Cystic Duct. Indian Journal Of Applied Research. 2017;7(2):230-33.
[11]. Singh SNP, Kumar P. Assessment of the cystic duct anomalies in patients undergoing laparoscopic cholecystechtomy in Bihar Population. International Journal of Medical Health Research. 2018;4(10): 227-29.
[12]. Rajguru J, Dave M. The Morphological Aberrations of Cystic Duct and its Clinical Significance: A Gross Anatomical Study. International Journal of Anatomy, Radiology and Surgery. 2018; 7(2): AO23-AO28.
[13]. Gupta S, Yadav PR, Kedawat A. Incidence of gall bladder and hepatobiliary anomalies: an institutional study. Journal of Dental and Medical Sciences. 2019; 18(8):40-47.
[14]. Dandekar UK, Dandekar KN. Anatomical study of cystic duct and its clinical correlation. Medpulse International Journal of Anatomy. 2019; 11(3):62-65.
[15]. Buddingh KT, Morks AN, Hoedemaker HOTC, Blaauw CB, van dam GM, Ploeg RJ et al. Documenting correct assessment of biliary anatomy during laparoscopic cholecystectomy. Surgical Endoscopy. 2012; 26(1):79–85.
[16]. Zhang C, Yin M, and Liu Q. The guidance impact of preoperative magnetic resonance cholangiopancreatography on laparoscopic cholecystectomy. Journal of Laparoendoscopic & Advanced Surgical Techniques Part A 2015; 25(9):720–23.
[17]. Itatani R, Namimoto T, Kajihara H, Yoshimura A, Katahira K, Nasu J et al. Preoperative evaluation of the cystic duct for laparoscopic cholecystectomy: comparison of navigator-gated prospective acquisition correction- and conventional respiratory-triggered techniques at free-breathing 3D MR cholangiopancreatography. European Radiology. 2013;23(7):1911–18.
[18]. Ausch C, Hochwarter G, Taher M, Rosen HR, Urban M, Sebesta C et al. Improving the safety of laparoscopic cholecystectomy: the routine use of preoperative magnetic resonance cholangiography. Surgical Endoscopy and Other Interventional Techniques. 2005;19(4):574–80.
[19]. Hatzidakis A, Venetucci P, Krokidis M, Iaccarino V. Percutaneous biliary interventions through the gallbladder and the cystic duct: what radiologists need to know. Clinical Radiology. 2014;69(12):1304–11.
[20]. Talpur KAH, Laghari AA, Yousfani SA, Malik AM, Memon AI, Khan SA. Anatomical variations and congenital anomalies of extra hepatic biliary system encountered during laparoscopic cholecystectomy. Journal of the Pakistan Medical Association. 2010; 60(2):89–93.
[21]. Onder H, Ozdemir MS, Tekbas G, Ekici F, Gumus H, Bilici A. 3-T MRI of the biliary tract variations. Surgical and Radiologic Anatomy. 2013;35(2):161–67.
[22]. Shaw MJ, Dorsher PJ, Vennes JA. Cystic duct anatomy: an endoscopic perspective. American Journal of Gastroenterology.1993; 88(12):2102–06.
[23]. Mortel´e KJ and Ros PR. Anatomicvariants of the biliary tree: MR cholangiographic findings and clinical applications. American Journal of Roentgenology. 2001;177(2):389–94.
[24]. Mortel´e KJ, Rocha TC, Streeter JL, and Taylor AJ. Multimodality imaging of pancreatic and biliary congenital anomalies. Radiographics. 2006; 26(3):715–31.
[25]. Taourel P, Bret PM, Reinhold C, Barkun AN, and Atri M. Anatomic variants of the biliary tree: diagnosis with MR cholangiopancreatography. Radiology. 1996;199(2):521–27.
[26]. Tsitouridis I, Lazaraki G, Papastergiou C, Pagalos E, and Germanidis G. Low conjunction of the cystic duct with the common bile duct: does it correlate with the formation of common bile duct stones? Surgical Endoscopy and Other Interventional Techniques. 2007;21(1):48–52.
[27]. Kao JT, Kuo CM, Chiu YC, Changchien CS, and Kuo CH. Congenital anomaly of low insertion of cystic duct:endoscopic retrograde cholangiopancreatography findings and clinical significance. Journal of Clinical Gastroenterology. 2011;45(7):626–29.
[28]. George RA, Debnath J, Singh K, Satija L, Bhargava S, and Vaidya A. Low insertion of a cystic duct into the common bile duct as a cause for a malpositioned biliary stent: demonstration with multidetector computed tomography. Singapore Medical Journal. 2009;50(7):243–46.
[29]. Selvaggi F, Cappello G, Astolfi A, Sebastiano PD, Ciotto ND, Bartolomeo ND et al. Endoscopic therapy for type B surgical biliary injury in a patient with short cystic duct. Il Giornale di Chirurgia. 2010;31(5):229–32.
[30]. Awazli LG. Anatomical variations of extrahepatic biliary system. Iraqi Journal of Medical Science. 2013;11(3):258–64.
[31]. CarbajoMA, Mart´ın del Omo JC, Blanco JI, Cuesta C, Martin F, Toledano M et al. Congenital malformations of the gallbladder and cystic duct diagnosed by laparoscopy: high surgical risk. Journal of the Society of Laparoendoscopic Surgeons. 1999; 3(4):319–21.

Cite this article: Sushant Agarwal, Pradipta Ray Choudhury, Krishna Kanta Biswas, Prabahita Baruah, Abhamoni Baro. Anatomical Variations of Cystic Ducts in Magnetic Resonance Cholangiopancreatography: A Retrospective Study With 265 Patients. Int J Anat Res 2022;10(3):8391-8397. DOI: 10.16965/ijar.2022.160