Morphometric study of extra-hepatic biliary pathways: study in human corpses / Estudio morfométrico de las vías biliares extrahepáticas: estudio en cadáveres humanos

SUMMARY: Adverse events (AE) contribute significantly to postoperative morbidities and comorbidities. Many AEs occur due to a lack of anatomical knowledge and its variants. Latrogenic bile duct injuries, for instance, represent a serious surgical complication of laparoscopic cholecystectomy. Anatomical knowledge for the identification and adequate drainage of all ducts is relevant and fundamental in order to avoid future errors. The objective of the study was to morphometrically analyze the bile ducts in adult human corpses. 13 livers were extracted from adult human corpses to obtain the ducts: choledochal, common hepatic and cystic. After morphological analysis, duct measurements (length and diameter) were continued using a digital caliper. The data obtained were tabulated in SPSS 21 program, performing descriptive analysis with mean and standard deviation. The averages of bile ducts were 61.05 (± 16.43) mm in length and 3.86 (± 0.72) mm in diameter. The cystic duct length and diameter averages were 33.59 (± 12.29) mm and 3.40 (± 0.79) mm, respectively. The common hepatic ducts had an average of 30.02 (± 7.19) mm in length and 3.74 (± 1.18) mm in diameter. The analyzed samples presented different values ?? from those already described in the literature, where the length of the cystic ducts was greater, while the length of the common hepatic ducts was numerically smaller. This work is very significant, as the morphometric variability of the bile ducts allows for varying morphological situations that can compromise the hepatobiliar physiology.

RESUMEN: Los eventos adversos (EA) contribuyen significativamente a las morbilidades y comorbilidades postoperatorias. Muchos EA se deben a la falta de conocimiento de la anatomía y sus variaciones. Por ejemplo, las lesiones iatrogénicas de las vías biliares representan una complicación quirúrgica grave de la colecistectomía laparoscópica. El conocimiento anatómico para la identificación y drenaje adecuado de todos los conductos es relevante y fundamental para evitar futuros errores. El objetivo del estudio fue analizar morfométricamente las vías biliares en cadáveres humanos adultos. Se extrajeron 13 hígados de cadáveres humanos adultos y se retiraron los conductos: colédoco, hepático común y cístico. Después del análisis morfológico, se continuó con las mediciones de los conductos (longitud y diámetro) utilizando un calibrador digital. Los datos fueron tabulados en el programa SPSS 21, mediante análisis descriptivos con media y desviación estándar. Los promedios de las vías biliares fueron de 61,05 (± 16,43) mm de longitud y 3,86 (± 0,72) mm de diámetro. Los promedios de longitud y diámetro del conducto cístico fueron 33,59 (± 12,29) mm y 3,40 (± 0,79) mm, respectivamente. Los conductos hepáticos comunes tenían un promedio de 30,02 (± 7,19) mm de longitud y 3,74 (± 1,18) mm de diámetro. Las muestras analizadas presentaron valores diferentes a los ya descritos en la literatura, donde la longitud de los conductos císticos era mayor, mientras que la longitud de los conductos hepáticos comunes fue numéricamente menor. Este trabajo es significativo, debido a que la variabilidad morfométrica de las vías biliares y permite identificar situaciones morfológicas que pueden comprometer la fisiología hapatobiliar.

Tumor hepático con vías biliares normales en un paciente con síndrome de Alagille: a propósito de un caso / Liver mass containing normal bile ducts in an Alagille patient: a case report

En este artículo se informa el caso de un paciente con síndrome de Alagille, que desarrolló una lesión de crecimiento rápido en el lóbulo caudado del hígado cirrótico. Se realizó el seguimiento riguroso del tumor aunque, desde el punto de vista radiológico, no parecía ser maligno. En el estudio por resonancia magnética (RM), no se observó ningún criterio diagnóstico de carcinoma hepatocelular; no obstante, se realizó una biopsia de la lesión y del hígado debido al rápido crecimiento del tumor. Los resultados del informe anatomopatológico indicaron desarrollo normal de los conductos biliares en el tumor y escasez de conductos biliares en la segunda muestra del hígado. Describiremos este caso y propondremos una interpretación de estos resultados.

This manuscript reports a case of a patient with Alagille syndrome who developed a rapidly growing lesion in the caudate segment of his cirrhotic liver. This mass was closely monitored but did not seem malignant from a radiological point of view. An MRI showed no criteria in favour of a hepatocarcinoma, however, the rapid growth lead to a biopsy of both the lesion and the cirrhotic liver. The pathology results indicated normal development of the bile ducts in the mass and paucity of the biliary ducts in the second liver specimen. We will describe this case and propose an interpretation of these findings.

A study on the number and arrangement of the structures passing through the porta hepatis in South Indian population / Estudio sobre el número y disposición de las estructuras que pasan por la fisura porta hepática en individuos del sur de la India

The porta hepatis of the liver is a very important area surgically. The knowledge of the variations in the structures passing through the porta hepatis might be of great help in reducing the risks of surgery in this area. In the current study 59 livers from South Indian cadavers were observed for the number and arrangement of the structures passing through the porta hepatis. In all the livers the portal vein was posteriormost and the hepatic duct was the anteriormost structure. The hepatic artery and its branches were in between the duct and the vein. The mean weight of the liver was 1.025 kg. The mean length of porta hepatis was 4.825 cm and the mean breadth was 2.433 cm. The number varied from one to three for the duct and vein but for the artery it was between one and four. In 51% of livers, only one vein and in 80% of cases only one duct passed through the porta hepatis. In 56% of cases two arteries passed through the porta hepatis.

La fisura porta hepática del hígado es un área quirúrgica muy importante. El conocimiento de las variaciones en las estructuras que pasan a través de la fisura porta hepática puede ser de gran ayuda para reducir los riesgos de la cirugía de esta región. En el presente estudio se observaron 59 hígados procedentes de cadáveres del Sur de la India, en relación al número y disposición de las estructuras que pasan a través de la fisura porta hepática. En todos los hígados, la vena porta hepática fue el elemento más posterior y el conducto hepático común el más anterior. La arteria hepática y sus ramas se ubicaban entre el conducto hepático común y la vena porta hepática. El peso medio de los hígados fue 1,025 kg. La longitud media de la fisura porta hepática fue 4,825 cm y el ancho medio de 2,433 cm. El número varió de uno a tres para el conducto y la vena. El número de arterias varió entre una y cuatro. En 51% de los hígados, sólo una vena pasaba a través de la fisura porta hepática y en el 80% de los casos sólo pasaba un conducto. En el 56% de los casos, dos arterias pasaban a través de la fisura porta hepática.

Multiple anatomical variations of the hepatic pedicle: case report and clinical application / Múltiples variaciones anatómicas del pedículo hepático: reporte de caso y aplicación clínica

The knowledge in detail of the anatomy of the hepatic pedicle is critical when operating it and its surroundings. The presence of anatomic variations is higher at the arterial component level than at the bile component level or venous component level, which in the 90% of the cases it appears as the classic description. The presented case in this work implies a very low frequency of appearance. For this reason, the surgeon must be alert at the moment of making a decision so as to avoid injuries that may put the patient´s life at risk.

El conocimiento en detalle de la anatomía del pedículo hepático es fundamental al momento de intervenir quirúrgicamente sobre el mismo y su vecindad. La presencia de variaciones anatómicas es mayor a nivel del componente arterial, luego biliar y finalmente venoso, el cual en el 90% de los casos se dispone de acuerdo con la descripción clásica. El caso presentado en este trabajo supone una muy baja frecuencia de aparición, siendo precisamente estas disposiciones poco habituales las que obligan al cirujano a mantenerse alerta en el momento de actuar para evitar injurias que puedan comprometer la vida del paciente.

Identificación en tiempo real de la anatomía biliar mediante fluorescencia utilizando fluoresceína sódica / Real time identification of biliary anatomy by fluorescence using fluorescein sodium

Objetivo: Desarrollar, en un modelo experimental animado, la técnica de colangiografía intraoperatoria utilizando fluoresceína sódica. Determinar la dosis de fluoresceína sódica necesaria para obtener la mejor visualización de la vesícula y del árbol biliar. Método: Estudio de tipo experimental, en el que se incluyeron 6 conejos albinos de raza Nueva Zelanda, distribuidos en 3 grupos equitativamente, según la dosis de fluoresceína sódica (5 mg/kg, 7,5 mg/kg, 15 mg/kg). Cumplido el protocolo anestésico, se administró la dosis de fluoresceína sódica según el grupo correspondiente, vía endovenosa. Se realizó una laparotomía por línea media superior, exteriorizándose el hígado y se realizó una maniobra de eversión, para la fácil identificación del sistema biliar extrahepático. Posteriormente, y con los sistema de iluminación, se registraron los parámetros de fluorescencia con cada dosis. No se realizó eutanasia. Ambiente: Centro veterinario privado "Colmillos y garras" Resultados: En todos los casos se logró registrar fluorescencia, siendo la dosis que permitió una mejor visualización la de 7,5 mg/kg. El tiempo promedio en el cual se empezó a ver fluorescencia en la vesícula biliar fue de 5 minutos; el tiempo promedio en el cual se alcanzó la totalidad del fenómeno fue de 18 minutos y, en todos los casos, la fluorescencia persistió por 30 minutos. Conclusión: La identificación de las vías biliares guiada por fluorescencia, utilizando fluoresceína sódica y con la fuente de luz UV de 5 mm de diámetro diseñada por los autores es factible, siendo la dosis con mejor visualización, la de 7,5 mg /kg de peso(AU)

Objective: To develop an experimental animal model technique using sodium fluorescein intraoperative cholangiography. To Determine the dose of sodium fluorescein necessary for the best display of the gallbladder and biliary tree. Methods: Experimental study. 6 New Zealand white albino rabbits divided into 3 groups depending on the dose of sodium fluorescein (5 mg / kg, 7.5 mg / kg, 15 mg / kg) were used. Prior anesthetic protocol corresponding fluorescein sodium was administered according included Animal group intravenously. Upper midline incision was used, exteriorization of the liver allow easy identification of extrahepatic biliary system and subsequently illuminated with fluorescence. Parameters were recorded for each dose. No euthanasia was performed. Environment: Private Veterinary Centre "Colmillos y Garras". Results: In all cases, we recorded fluorescence. The dose that allowed the best visualization was 7.5 mg / kg. The average time in which fluorescence began to be visible in the gallbladder was 5 minutes, the average time in which the total fluorescence was reached was 18 minutes in all cases fluorescence persisted until 30 minutes. Conclusion: Laparoscopic cholecystectomy guied using sodium fluorescein fluorescence and UV light source of 5 mm diameter is feasible. Better visualization is obtained with the dose 7.5 mg / kg(AU)

Os achados de imagem para avaliação da tríade portal são confiáveis para realização do transplante hepático com doador vivo? / Are the imaging findings used to assess the portal triad reliable to perform living-donor liver transplant?

RACIONAL: Um aspecto crucial do transplante hepático inter-vivos é o risco imposto ao doador, devido ser procedimento realizado em pessoa saudável, com possibilidade de alta morbidade pós-operatória. OBJETIVO: Correlacionar os achados de imagem do pré e intra-operatório dos doadores adultos vivos de fígado. MÉTODOS: No período de 2003 a 2008 foram revisados os prontuários de 66 doadores. Foram 42 homens (64%) e 24 mulheres (36%), com média de idade de 30 anos (± 8 anos). A anatomia pré-operatória foi analisada através de colangiografia por ressonância nuclear magnética para estudo dos ductos biliares e angiografia por tomografia computadorizada para artéria hepática e veia porta. Critérios de normalidade foram estabelecidos de acordo com estudos prévios da literatura. RESULTADOS: Variações anatômicas dos ductos biliares foram encontradas em 59,1% dos doadores; da artéria hepática em 31,8% e da veia porta em 30,3% dos casos no pré-operatório. A colangiografia por ressonância nuclear magnética apresentou achados concordantes em 44 (66,6%) doadores e discordantes em 22 (33,3%). Com relação à artéria hepática em todos os doadores os achados do exame de imagem foram concordantes com os do intra-operatório. Para a veia porta a tomografia computadorizada apresentou achados concordantes em 59 (89,4%) doadores e discordantes em sete (10,6%). CONCLUSÕES: As variações anatômicas dos ductos biliares são frequentes, com a colangiografia por ressonância nuclear magnética apresentando acurácia moderada (70%) na reprodução dos achados cirúrgicos; a tomografia computadorizada reproduziu os achados do intra-operatório da artéria hepática em 100% dos doadores, e reproduziu os achados intra-operatórios em 89,4% dos casos em relação à veia porta, apresentando acurácia elevada (89%).

BACKGROUND: A crucial aspect of living-donor liver transplant is the risk imposed to the donor due to a procedure performed in a healthy individual that can lead to a high postoperative morbidity rate AIM: To correlate the pre- and intraoperative hepatic imaging findings of living adult donors. METHODS: From 2003 to 2008 the medical charts of 66 donors were revised; in that, 42 were males (64%) and 24 females (36%), mean age of 30±8 years. The preoperative anatomy was analyzed by magnetic resonance cholangiography to study the bile ducts and by computed tomography angiography to evaluate the hepatic artery and portal vein. Normalcy criteria were established according to previously published studies. RESULTS: Anatomic variations of the bile ducts were found in 59.1% of donors, of the artery hepatic in 31.8% and of the portal vein in 30.3% of the cases during the preoperative period. The magnetic resonance cholangiography findings were in agreement in 44 (66.6%) of donors and in disagreement in 22 (33.3%). With regards to hepatic artery, in all donors the findings of the imaging examination were in agreement with those of the intraoperative period. As to the portal vein, the computed tomography findings were in agreement in 59 (89.4%) donors and in disagreement in seven (10.6%). CONCLUSIONS: The bile duct anatomic variations are frequent, and the magnetic resonance cholangiography showed moderate accuracy (70%) in reproducing the surgical findings; the computed tomography reproduced the intraoperative findings of the hepatic artery in 100% of donors, and of the portal vein in 89.4% of the cases, thus demonstrating high accuracy (89%).

Quistes de colédoco: un diagnóstico inadvertido. Serie de casos / Choledochal cysts: an inadvertent diagnosis. Case series

Las lesiones quísticas de vías biliares, constituyen una entidad, que rara vez se observa o diagnostica en el adulto. El motivo de este trabajo es mostrar la experiencia de un centro de referencia biliopancreática en el diagnóstico y tratamiento de quistes de colédoco. Usamos la clasificación de Todani para la descripción de los mismos. Fue un estudio Descriptivo y Retrospectivo con 502 colangiopancreatografías retrógradas endoscópicas y de ellas 20 casos de quistes de colédoco identificados mediante colangiografías de alta calidad.

Cystic lesions of the bile ducts constitute an entity that is rarely seen or diagnosed in adults. The purpose of this study is to show the experience of a biliopancreatic referral center in the diagnosis and treatment of choledochus cysts. The Todani classification was used to describe them. It was a retrospective, descriptive study of 502 endoscopic retrograde cholangiopancreatographies and of these 20 cases of choledochal cysts were identified by high-quality cholangiographies.

Variedades anatómicas del árbol biliar: implicancia quirúrgica / Anatomy variations of biliary tree: surgical implicance

La anatomía de las vías biliares presenta frecuentes variaciones. La anatomía "normal" se describe en aproximadamente la mitad de los casos. Las variedades de las vías biliares deben ser conocidas por los médicos especialistas en diagnóstico por imágenes y cirujanos hepatobiliares, a fin de optimizar su desempeño en sus respectivas áreas. Con ese fin fueron estudiadas en forma prospectiva 690 colangiografías (538 intra-operatorias; 90 resonancias; y 62 trans-catéteres biliares). Se utilizó la clasificación de Blumgart y los resultados fueron: tipo A: 284 (41,16 por ciento); B: 178 (25,80 por ciento). C1: 110 (15,94 por ciento); C2: 38 (5,51 por ciento).; D1: 8 (1,16 por ciento); D2: 23 (3,33 por ciento); E1: 18 (2,61 por ciento); E2: 27 (3,91 por ciento); F: 4 (0,58 por ciento). Como conclusiones, es importante señalar que: a) la colangiografía intra-operatoria debe ser sistemática, por un lado, para descartar litiasis coledociana; y por el otro, para detectar variaciones anatómicas y predecirlas antes de las cirugías resectivas; y b) la colangiorresonancia es ideal como estudio preoperatorio en posibles donantes vivos de órganos.

The anatomy of the biliary tract have frequent variations. Normal anatomy is described in about half of cases. The varieties of the bile ducts should be known by physicians and hepatobiliary surgeons specializing in diagnostic imaging, in order to optimize performance in their respective areas. To this end 690 cholangiographies (538 intra-operative, 90 resonances, and 62 trans-catheter bile) were prospectively studied. We used the classification of Blumgart and the results were as follows: type A: 284 (41.16 percent), B: 178 (25.80 percent). C1: 110 (15.94 percent), C2: 38 (5.51 percent)., D1: 8 (1.16 percent), D2: 23 (3.33 percent), E1: 18 (2.61 percent) , E2: 27 (3.91 percent), F: 4 (0.58 percent). As conclusion, it is important to note that: a) intra-operative cholangiography should be systematic, on the one hand, to exclude cholelithiasis and, on the other hand, to detect and predict anatomical changes before resective surgery and b) cholangioresonance is an ideal preoperative study in potential living donors of organs.

Comparação entre exames de imagem e achados operatórios em doadores para transplante hepático intervivos / Comparison of pre-operative exams and per-operative findings in living donor liver transplantation

RACIONAL: No transplante hepático intervivos a anatomia da tríade portal e da drenagem venosa hepática do doador são de suma importância para o sucesso do procedimento. OBJETIVO: Analisar comparativamente os achados de exames de imagem no pré-operatório com os achados cirúrgicos em relação à anatomia da tríade portal e veias de drenagem hepática em doadores para transplante hepático intervivos. MÉTODOS: No período de março de 1998 a agosto de 2005 foram revisados os prontuários dos doadores para transplante hepático intervivos realizados no Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, PR. A anatomia no pré-operatório foi analisada através de: a) arteriografia celíaca e mesentérica para a artéria hepática e veia porta (fase venosa); b) ressonância magnética para a drenagem venosa, veia porta e vias biliares. Critérios de normalidade foram estabelecidos de acordo com estudos da literatura. Os achados pré-operatórios foram comparados com os achados peroperatórios no doador. RESULTADO: Em relação à anatomia da veia porta e artéria hepática foram estudados 44 pacientes, 16 do sexo feminino e 28 do sexo masculino, com idade média de 33 anos. Em 8 casos foi captado o lobo hepático esquerdo para receptor pediátrico e em 36 casos o lobo hepático direito para receptor adulto. Em relação à anatomia biliar foram estudados 37 casos e em relação à anatomia da drenagem venosa, 32 casos. No total, em 36,36 por cento dos casos, os achados referentes à anatomia nos exames pré-operatórios não coincidiram com os achados peroperatórios. Para a artéria hepática os achados foram discordantes em 11,36 por cento dos casos, para a veia porta foram discordantes em 9,1 por cento, para a drenagem venosa em 9,37 por cento e para as vias biliares em 21,6 por cento. CONCLUSÃO: São freqüentes achados discrepantes referentes à anatomia da tríade portal e drenagem venosa hepática na análise pré-operatória do doador para transplante hepático intervivos...

BACKGROUND: Success in living donor liver transplantation is associated to donor vascular and biliar anatomy. AIM: Compare pre-operative and per-operative findings in living liver donors related to portal vein, hepatic artery, bile duct and hepatic venous drainage anatomy. METHODS: Donors charts of living donor liver transplants done at Clinics Hospital of the Federal University of Paraná, Curitiba, PR, Brazil, were reviewed between March 1998 and August 2005. On the pre-operative period the anatomy was analysed through: celiac and mesenteric arteriography of the hepatic artery and portal vein (venous phase); magnetic resonance imaging of the venous drainage, portal vein and bile duct. Normality was determined based on data of the literature. Pre-operative findings were compared to per-operative findings. RESULTS: Portal vein and hepatic artery were studied in 44 patients, 16 females and 28 males, mean age of 33 years old. In 8 cases the left liver lobe was used to pediatric receptor, in 36 cases the right liver lobe was used to adult receptor. Bile duct anatomy was studied in 37 cases and venous drainage in 32. Over all, the findings related to pre-operative and per-operative anatomy were not coincident in 36.36 percent of the cases. In the case of hepatic artery, they were not coincident in 11.36 percent, in the case of the portal vein in 9.1 percent, in the case of the venous drainage in 9.37 percent and in the case of the bile duct in 21.6 percent. CONCLUSION: The pre-operative and per-operative findings related to vascular and bile duct donor anatomy are frequently different in living donor liver transplantation.

Anatomia das vias biliares em doadores e receptores de transplante hepático inter vivos / Study of biliary anatomy in living related liver transplantation / Study of biliary anatomy in living related liver transplantation

RACIONAL: Variações anatômicas das vias biliares são freqüentes e aumentam as complicações dos transplantes hepáticos. OBJETIVO: Avaliar a anatomia das vias biliares nos doadores e receptores do transplante hepático inter vivos realizados no Hospital de Clínicas da Universidade Federal do Paraná e do Hospital Nossa Senhora das Graças de Curitiba, Curitiba, PR. CASUíSTICA E MÉTODOS: A avaliação foi retrospectiva de março de 1998 até setembro de 2002 (23 transplantes), quando os dados passaram a ser captados de forma prospectiva (17 transplantes), até agosto de 2003. Foram obtidos dados de 80 pacientes consecutivos (40 doadores e 40 receptores), submetidos a transplante hepático inter vivos, sendo 32 transplantes com receptor adulto e 8 transplantes pediátricos (receptor com idade inferior a 15 anos). Entre os 80 pacientes incluídos no estudo, 51 eram do sexo masculino (27 receptores e 24 doadores) e 29 do feminino (13 receptores e 16 doadores). A idade média dos doadores foi de 32,6 anos e a dos receptores de 36,3 anos. RESULTADOS: Nas cirurgias de captação do lobo hepático direito, a via biliar direita foi única em 25 entre 29 casos (86,2 por cento), dupla em dois (6,9 por cento) e tripla em dois (6,9 por cento). Nos oito casos em que o setor lateral esquerdo ou o lobo hepático esquerdo foram captados, a via biliar foi única. Entre os 33 pacientes submetidos a colangiografia por ressonância magnética, variações foram verificadas em três pacientes (9,1 por cento), sendo a mais comum o ducto biliar posterior direito tributário do ducto hepático esquerdo (6,06 por cento; n = 2). CONCLUSÃO: A prevalência de anomalias biliares nos transplantes inter vivos de fígado é elevada e algumas não são diagnosticadas com os exames de imagem pré-operatórios.

BACKGROUND: Anatomic variations of the biliary tree are frequent and increase complications after liver transplantation. AIM: To describe the anatomy of the bile ducts of donors and recipients of living related liver transplantation. METHODS: From March 1998 to September 2002, the study was retrospective (23 transplantations). From October 2002 to August 2003, the study was prospective (17 transplantations). We studied the hepatic anatomy of 80 consecutive patients (40 donors and 40 recipients) of the living-related liver transplantation program of the "Hospital de Clínicas da Universidade Federal do Paraná" and the "Hospital Nossa Senhora das Graças", Curitiba, PR, Brazil; 51 were male (27 recipients 24 donors) and 29 female (13 recipients and 16 donors). The median age among the donors was 32.6 years and among the recipients was 36.3 years. Thirty-two recipients were adults and 8 recipients were under 15 years old. The bile duct anatomy was studied by magnetic resonance cholangiography in 33 patients, and anomalies were seen in 3 of them (9.1 percent). RESULTS: The most prevalent variation of bile ducts was the fusion of the right posterior duct with the left duct (6.06 percent; n=2). In the 40 harvesting operations, the right bile duct was single in 25 patients (87.5 percent), among the 32 right-lobe donors, double in 2 (6.25 percent) and triple in 2 (6.25 percent). All of the eight left livers procured had single bile ducts. Among the 40 recipients, the common bile duct was bifurcated in 2 of them (5 percent). CONCLUSION: The prevalence of biliary anomalies is high in patients subjected to living liver transplantation and some anomalies are not diagnosed with preoperative imaging exams.

Variantes anatômicas e anomalias congênitas das vias biliares e pancreáticas: análise através da colangiopancreatografia por ressonância magnética / Anatomic variants and congenital abnormalities of the biliary tree seen on magnetic resonance cholangiopancreatography

Com o objetivo de ilustrar, de maneira sistematizada, as principais variantes anatômicas e anomalias congênitas observadas em exames de colangiopancreatografia por ressonância magnética (CPRM), realizamos estudo retrospectivo em exames de CPRM com as mais diversas indicações, procurando por variantes anatômicas e anomalias congênitas das vias biliares e pancraáticas. Todos os exames foram realizados em equipamento de alto campo (1,0 T ou 1,5 T), obtendo-se imagens no plano axial ponderadas em T1 (FFE) e T2 (TSE), e no plano coronal, com técnica de CPRM. Apresentamos variantes anatômicas relacionadas à posição da vesícula biliar, à distribuição e posição das vias biliares intra-hepáticas, do ducto cístico, ducto colédoco e ductos pancreáticos. Mostramos também exemplos dos principais tipos de dilatação cística congênita das vias biliares. Reconhecer as principais variantes anatômicas e anomalias congênitas das vias biliares e pancreáticas permite otimizar a eficácia diagnóstica da CPRM.

In order to illustrate the role of magnetic resonance cholangiopancreatography (MRCP) in the diagnosis of anatomic variants and congenital abnormalities of the biliary tree, we onducted a retrospective study of MRCP scans performed due to different indications to identify anatomic variants and congenital abnormalities of the pancreas and biliary tree. High field MR machines (1.0 T and 1.5 T) and 3D TSE sequences were used to obtain images in the axial and coronal planes with MIP reconstructions in all studies. MRCP showed low cystic duct insertion, medial cystic duct insertion, and a parallel course of the cystic and hepatic ducts as well as bile duct bifurcation abnormalities and aberrant right and left hapatica duct. We also present examples of the main types of congenital cystic dilatation of the bile ducts. The recognition of the main anatomic variants of the biliary tree and pancreatic ductshelps to optimize the diagnostic accurancy of MR cholangiopancreatography.

The Relationship of Anatomic Variation of Pancreatic Ductal System and Pancreaticobiliary Diseases

The aims of this study were to identify the morphological diversities and anatomical variations of pancreatic ductal system and to define the relationships between pancreatic ductal systems, pancreaticobiliary diseases, and procedure-related complications, including post-ERCP pancreatitis. This study included 582 patients in whom both pancreatic duct (PD) and common bile duct were clearly visible by ERCP. PD systems were categorized into four types according to the relationship between common bile duct and PD. In types A and B, Wirsung duct formed the main PD. In type C, Wirsung duct did not form the main PD. If PD system did not fall into any of these three types, it was categorized as type D. The distribution of types among pancreatic ducts examined was as follows: type A: 491 cases (84.4%), type B: 56 cases (9.6%), type C: 20 cases (3.4%), and type D: 15 cases (2.6%). The anomalous anatomic variations of PD systems were divided into migration, fusion, and duplication anomalies. PD anomalies were noted in 51 patients, of which 19 (3.3%) were fusion anomalies (12 complete pancreas divisum, 7 incomplete pancreas divisum), and 32 (5.5%) were duplication anomalies (5 number variations, 27 form variations). No significant relationships between various PD morphologies and pancreaticobiliary diseases were found. However, post- ERCP hyperamylasemia was more frequently found in types C (41.7%), D (50%) and A (19.8%) than in type B (9.4%). In summary, whether Wirsung duct forms the main PD and the presence or absence of the opening of the Santorini duct are both important factors in determining the development of pancreatitis and hyperamylasemia after ERCP.

Gadobenate Dimeglumine as an Intrabiliary Contrast Agent: Comparison with Mangafodipir Trisodium with Respect to Non-dilated Biliary Tree Depiction

OBJECTIVE: To compare the efficacy of Mangafodipir trisodium (Mn-DPDP) -enhanced MR cholangiogrphy (MRC) and Gadobenate dimeglumine (Gd-BOPTA) -enhanced MRC in visualizing a non-dilated biliary system. MATERIALS AND METHODS: Eighty-eight healthy liver donor candidates underwent contrast-enhanced T1-weighted MRC. Mn-DPDP and Gd-BOPTA was used in 36 and 52 patients, respectively. Two radiologists reviewed the MR images and rated the visualization of the common duct, the right and left hepatic ducts, and the second-order branches using a 4-point scale. The contrast-to-noise ratio (CNR) of the common duct to the liver in the two groups was also compared. RESULTS: Mn-DPDP MRC and Gd-BOPTA MRC both showed similar visualization grades in the common duct (p = .380, Mann-Whitney U test). In the case of the proximal bile ducts, the median visualization grade was significantly higher with Gd-BOPTA MRC than with Mn-DPDP MRC (right hepatic duct: p = 0.016, left hepatic duct: p = 0.014, right secondary order branches: p = 0.006, left secondary order branches, p = 0.003). The common duct-to-liver CNR of the Gd-BOPTA MRC group was significantly higher (38.90+/-24.50) than that of the Mn-DPDP MRC group (24.14+/-17.98) (p = .003, Student's t test). CONCLUSION: Gd-BOPTA, as a biliary contrast agent, is a potential substitute for Mn-DPDP.

Liver weight and the dimensions of its vessels and biliary ducts: a study on 40 Iranian cadavers

The number of liver transplantations are increasing in Iran. Precise knowledge concerning the anatomical dimensions and the effect of racial and environmental factors on them is of importance. This study was carried out to determine the anatomical dimensions of the liver, its vessels and biliary ducts in cadavers autopsied in the Medical Foundation in 1997. A total number of 40 cadavers without any abdominal surgeries or crushed intra-abdominal organs were studied. The personal and demographics attributes along with anatomical dimensions of the hepatic artery, portal vein, biliary, hepatic and cystic ducts ducts, their variants and probable anomalies along with the total liver weight were recorded. The cadavers were within the age range of 37 +/- 9 years and the weight range of 64 +/- 9 Kg. In all cases the portal vein was normal with a length ranging 8.3 +/- 2.2 cm. In 15% of the subjects the hepatic artery [right branch of superior mesenteric artery] was abnormal. The length of extra-hepatic ducts was 8.6 +/- 1.7 cm and the weight of the liver was 1453 +/- 260 g. The anatomical dimensions of liver, its vessels and biliary ducts were different from western reports. It is recommended to perform more detailed research on corpses from habitants of the region

Principais variacoes do sistema biliar extra-hepatico e sua aplicacao na tecnica de transplante de figado chamada "split-liver" / Study of the hepatic duct system for application of the split-liver transplantation techruque

Estudou-se 60 figados de cadaveres frescos de adultos com o tronco celiaco, cabeca do pancreas e arteria mesenterica. Os ductos biliares extra-hepaticos direito, esquerdo e medio foram dissecados bem como suas ramificacoes. O ducto hepatico direito era unico em 13 (21,6 por cento) dos casos e multiplo em 47 (78,3 por cento). O ducto hepatico esquerdo era unico em 3 (5 por cento) dos casos e multiplos em 57 (95 por cento). O ducto hepatico medio apareceu em 18 (30 por cento) casos sendo 2(3,3 por cento) casos multiplo. Em conclusao, com relacao a drenagem biliar hepatica a tecnica de transplante de figado "split-liver" e factivel desde que se tenha consciencia da presenca do ducto hepatico medio o que em aproximadamente 3 por cento dos casos ele e multiplo.

Variaçöes anatómicas da via biliar principal em estudos radiológicos / Anatomic variances in principal biliary tract in radiologics studies

A via biliar é uma sede frequente de variaçöes anatômicas. Seu conhecimento é importante principalmente sob o ponto de vista cirúrgico. Com o objetivo de estudar as principais alteraçöes anatômicas da via biliar principal "in vivo", investigaram-se retrospectivamente 86 colangiografias peroperatórias de colescistectomias por litíase biliar. Os resultados mostraram variaçöes da drenagem da via biliar direita em 13,1 por cento dos casos . A confluência dos ductos principais apresentou variaçöes em 14,5 por cento dos casos. O ducto cístico apresentou trajeto retilíneo em 87,5 por cento, dos casos, sendo espiralado em 2,5 por cento e inserido próximo ao duodeno em 10 por cento. Concluindo, o exame colangiográfico peroperatório evidenciou algumas variaçöes morfológicas. Julgamos prudente a realizaçäo desse exame näo só para caracterizar doenças das vias biliares, mas também para orientar o cirurgiäo, com vista a possíveis alteraçöes anatômicas que podem ser causa de incidentes cirúrgicos

Sistema excretor do fígado de veados (Manzana americana, Blastocerus bezoarticus e Mangana simplicicornis). II. Sistematizaçäo do ramus principalis sinister / Excretory system on the liver in deers (Manzana americana, Blastocerus bezoarticus and Manzana simplicicornis). II. Ramus principalis sinister

A sistematizaçäo do ramus principalis sinister do sistema excretor do fígado foi estudada em 8 peças retiradas de 6 veados mateiros (Manzana americana) 1 veado catingueiro (Manzana simplicicornis) e 1 veado do rabo branco (Blastocerus bezoarticus). Foi utilizado látex Neoprene corado para o preenchimento das vias biliares, e o método empregado para a evidenciaçäo dos coletores foi o da dissecaçäo, realizada após a fixaçäo das peças com soluçäo aquosa de formol a 10 por cento. Nas três espécies, participam do sistema do ramus principalis sinister sob diferentes arranjos, o ramus dorsalis lobi sinistrum, o truncus intermediomedialis, o truncus intermediolateralis, o ramus lateralis lobi sinistri e o ramus lobi quadrati. Do sistema de ductos ainda fazem parte contribuiçöes inominadas, vindas dos vários territórios hepáticos

Estudo anatômico das vias bilíferas em búfalos: comportamento do ductus choledocus, ductus cysticus e vesica fellea. Sistematizaçäo do ductus biliferus principalis dexter / Anatomical study of the ductus choledocus, ductus cysticus, vesica fellea and ductus biliferus principalis dexter in buffaloes

Os autores estudaram o comportamento do ductus choledocus, ductus cysticus e vesica fellea e a constituiçäo do ductus biliferus principalis dexter, parte das vias bilíferas em 40 búfalas da raça Jaffarabadi, adultas. Os fígados tiveram suas vias biliares injetadas com látex Neoprene 650 e celobar, e o procedimento utilizado pelos autores para evidenciaçäo dos componentes estudados foram a dissecaçäo e radiografias. Nos 40 órgäos analisados constatou-se que o ductus choledocus na maioria (97,5 por cento) sem tributários, acolhe num caso isolado (2,5 por cento) afluente inominado do lobus quadratus. Este ductus apresenta-se formado pela confluência do ductus biliferus principalis dexter e do sinister (75 por cento), pela confluência das raízes dorsomedial e ventrolateral mais o ductus biliferus principalis sinister (22,5 por cento), e pela junçäo do ductus hepaticus e ductus cysticus (2,5 por cento). O ductus cysticus, componente constante do ductus biliferus principalis dexter, associa-se ao ductus biliferus lateralis lobi dextri (67,5 por cento), enderençando-se nas outras glândulas (32,5 por cento) a troncos diversos. A vesica fellea em 87,5 por cento das peças mostra-se livre de afluentes, enquanto nas demais dissecaçöes (12,5 por cento) recebe ductos hepatocísticos oriundos apenas do lobus quadratus (5 por cento), simultaneamente do lobus dexter e do lobus quadratus (5 por cento), e unicamente do território lateral do lobus dexter (5 por cento). O ductus biliferus principalis dexter é formado pelo ductus lateralis lobi dextri e ductus cysticus (100 por cento) e pelo ductus medialis lobi dextri, ductus dorsalis lobi dextri e ductus processi caudati (92,5 por cento)

Intrahepatic bile duct development in the human foetus

This study included twenty human foetuses during various periods of gestation ranging from 9 to 40 weeks. The age of the foetus was approximately determined. Specimens from the liver were obtained and subjected to the appropriate histological and histochemical techniques. The data revealed that the bile duct system was immature at 9 weeks-old foetuses. Then at the 11th week, groups of hepatic cells were arranged in close contact with portal vein branches. At 12 weeks-old foetuses, the biliary ducts started to appear as small spaces among these groups of hepatic cells. At 18 to 20 weeks, portal spaces became obvious and duct-like structures were observed in the parenchyma-connective tissue contact area around these portal spaces. From the 21st week onwards, developing biliary structures were observed at the margins of the portal spaces. Then the portal mesenchymal tissue successively surrounded the bile ducts and pushed them inside portal spaces. At week 40, the number of large individual bile ducts increased in each portal area. The present results suggested that the cells lining the developing biliary structures originated from the hepatoblasts. The number of ductular structures per portal tract increased in full term foetal liver. Nevertheless, the bile canalicular system was less conspicuous till the full term gestational period suggesting that development will continue in the postantal life