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Bile Duct of Luschka Connecting with the Cystohepatic Duct: The Importance of Cholangiography During Surgery

Taku Aoki1, Hiroshi Imamura1, Yoshihiro Sakamoto1, Kiyoshi Hasegawa1, Yasuji Seyama1, Keiichi Kubota2 and Masatoshi Makuuchi1

1 Department of Surgery, Division of Hepato-Biliary-Pancreatic and Transplantation Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
2 Second Department of Surgery, Dokkyo University School of Medicine, 880 Mibu, Tochigi 321-0293, Japan.



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  		Fig. 1A. —79-year-old woman with rare combination of biliary anomalies. Photograph taken during pancreaticoduodenectomy shows biliary anomalies. Gallbladder was removed, and cystic duct was ligated and divided proximal to its junction with aberrant hepatic duct (white arrowhead). Common hepatic duct (black arrow) and aberrant hepatic duct (white arrow) were transected separately. Probe is inserted through stump of aberrant hepatic duct. Pinhole bile leakage in gallbladder bed was sutured (black arrowhead). CHA = common hepatic artery, RHA = replaced right hepatic artery, P = body of pancreas, SMV = superior mesenteric vein.

 


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  		Fig. 1B. —79-year-old woman with rare combination of biliary anomalies. Operative cholangiogram obtained through stump of aberrant hepatic duct shows that aberrant duct is cystohepatic duct. Thereafter, bile duct of Luschka (asterisk) is visualized, followed by hepatic duct of right paramedian sector and left hepatic duct. Sutured bile duct in gallbladder fossa is branch of bile duct of Luschka (arrowhead). Arrows indicate order of opacification. LHD = left hepatic duct, Para = hepatic duct of right paramedian sector.

 


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  		Fig. 1C. —79-year-old woman with rare combination of biliary anomalies. Operative cholangiogram obtained through common hepatic duct shows hepatic duct of right lateral sector, hepatic duct of right paramedian sector, and left hepatic duct, in that order. Bile duct of Luschka is not visualized. Para = hepatic duct of right paramedian sector, LHD = left hepatic duct, Lat = hepatic duct of right lateral sector.

 


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  		Fig. 1D. —79-year-old woman with rare combination of biliary anomalies. Schema of biliary system shows bile duct of Luschka (asterisk) acting as intrahepatic communicating branch between cystohepatic duct and hepatic duct of right paramedian sector. Para = hepatic duct of right paramedian sector, Lat = hepatic duct of right lateral sector, LHD = left hepatic duct, CHD = common hepatic duct, GB = gallbladder.

 

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