346 Med Arh. 2013 Oct; 67(5): 346-347 • ORIGINAL PAPER

Variations of Cystic Duct (CD) - Common Hepatic Duct (CHD) Junction Determined by ERCP

DOI: 10.5455/medarh.2013.67.346-347Med Arh. 2013 Oct; 67(5): 346-347Received: June 18th 2013 | Accepted: August 25th 2013

CONFLICT OF INTEREST: NONE DECLARED

ORIGINAL PAPER

Variations of Cystic Duct (CD) - Common Hepatic Duct (CHD) Junction Determined by ERCPBesnik Bicaj1,2, Sofika Qamirani3, Flamur Blakaj2, Teuta Bicaj2, Valon Zejnullahu1, Astrit Hamza1, 2, Faton Hoxha1, Sefedin Muçaj2

Department of endoscopy, Clinic of surgery, University Clinical Center of Kosova, Prishtine, Kosova1

Faculty of Medicine, Pristine University, Pristine, Kosova2

Faculty of Medicine, Tirana University, Tirana, Albania3

Introduction: Cystic Duct (CD) join Common Hepatic Duct (CHD) to the right with right angle close to 75% of cases and in 25% of cases like spiral intersects the CHD from above or behind and join it to his left to form the Common Bile Duct (CBD). There are authors who describe

that CD may join CHD at any level to form CBD. The importance of recognizing union of CD and CHD has significant importance for the surgeons that perform Cholecystectomy, in order to avoid injuries to the CHD or CBD. Aim of the study: to present the variations of CD-CHD junction determined by ERCP. To recognize variations of CD-CHD junction in Albanian population used in this study. To present differences of CD-CHD junction between male and female population. Methods and results: Data were taken from the protocols of ERCP that has been done in UCC of Kosova – Department of Endoscopy, Clinic of Surgery. During last 2 years period we have had 398 patients in ERCP from those we have determined CD-CHD junction on 148(37.85%) patients. 76 were Female (51.35%) and 72 male (48.65%). CD-CHD junction was identified as right junction in 117(79.05%) patients: UR in 64(43.24%), MR in 46(31.08%), LR in 7(4.73%). Left CD-CHD junc-tion was identified in 31(20.95%) of patients: UL in 4(2.70%), ML 6(4.07%) and LL in 21(14.18%) of patients. It is important to notice that Lower Left union of CD and CHD is rare or not prescribed in literature. We haven’t find significant differences between male and female groups according to right or left CD-CHD junction (p<0.05). There is deference between male and female in lower CD-CHD junction (p<0.01), and there is also deference between male and female in left lower CD-CHD junction (p<0.05).Conclusion: We conclude that CD-CHD junction was identified as right junction in 79.05% patients and as left CD-CHD junction was identified in 20.95%. There is deference between male and female in left lower CD-CHD junction (p<0.01). We have identified LL CD-CHD junction in 14.18% of patients and that is rare or not prescribed in literature. Key Words: CD-CHD junction, UCC-Kosovo.

Corresponding author: Ass. prof. Besnik Bicaj, MD, PhD–Candidate, University Clinical Center of Kosova, Clinic of Surgery, Department of Endoscopy, Pristine, Kosova; e-mail: besnikbicaj@yahoo.com

1. INTRODUCTIONExtra hepatic bile roads are: Left and

right Hepatic duct, Common Hepatic Duct (CHD), Cystic Duct (CD), Gall-bladder and Common Bile Duct (CBD). Gallbladders through the CD join with CHD and form the CBD. CHD has av-erage of 2-4cm in length. CD has vari-able length and joins the CHD in dif-ferent ways. There are authors who de-scribe the CD join CHD to the right

with right angle close to 75% of cases and in 25% of cases like spiral in-tersects the CHD from above or behind and join it to his left. Others say that DC may join CHD at any level to form CBD. The importance of recog-nizing union of CD and CHD has significant im-

portance for the surgeons that perform Cholecystectomy, in order to avoid in-juries to the CHD or CBD.

2. AIM OF STUDYTo present the variations of CD-

CHD junction determined by ERCP. To recognize variations of CD-CHD junction in Albanian population used in this study. To present differences of CD-CHD junction between male and female population.

3. METHODS AND RESULTSData were taken from the protocols

of ERCP that has been done in UCC of Kosovo – Department of Endoscopy, Clinic of Surgery. During last 2 years period we have had 398 patients in ERCP from those we have determined CD-CHD junction on 148(37.85%) pa-tients 76 female (51.35%) and 72 male (48.65%). For the study we grouped re-sults in 6 groups: UR (Upper Right), MR (Middle Right), LR (Lower Right), UL (Upper Left), ML (Middle Left) and LL (Lower Left) CD-CHD junction.

Tab. 1. CD-CHD junction distribution in all patients.

It is important to notice that Lower Left union is present in 14.18% of patients.

Tab. 2. CD-CHD junction distribution in male patients.

Figure 1. CD-CHD junction distribution in all patients.

347 Med Arh. 2013 Oct; 67(5): 346-347 • ORIGINAL PAPER

Variations of Cystic Duct (CD) - Common Hepatic Duct (CHD) Junction Determined by ERCP

CD-CHD junction was identified as right junc-tion in 117 (79.05%) pa-tients: UR in 64 (43.24%), MR in 46 (31.08%), LR in 7 (4.73%). Left CD-CHD junction was iden-tified in 31 (20.95%) of patients: UL in 4 (2.70%), ML 6 (4.07%) and LL in 21 (14.18%) of patients.

It is important to no-tice that Lower Left union is present in 14.18% of pa-tients.

Right CD-CHD junc-tion in male was in 79.81% of patients and left junc-tion in 19.45% of patients.

Right CD-CHD junc-tion in female was in 77.62% of patients and left junction in 19.45% of patients.

There is deference between male and female in lower CD-CHD junction

(p<0.01), and there is also deference be-tween male and female in left lower CD-CHD junction (p<0.05)

4. CONCLUSIONSWe conclude that CD-CHD junc-

tion was identified as right junction in 79.05% patients and as left CD-CHD junction was identified in 20.95%. We haven’t find significant differences be-tween male and female groups accord-ing to right or left CD-CHD junction (p<0.05). There is deference between male and female in left lower CD-CHD junction (p<0.01). We have identified LL CD-CHD junction in 14.18% of patients and that is rare prescribed in literature.

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tion. 2003. 285-286.2. Chemberlain RS. Blumgart LH. Hepatobiliary

Surgery. 2003. 10-16.3. Schwartz SI. Shires, Spenser. Principles of Sur-

gery. Fifth edition. 1989. 1381-1384.4. Maingot. Abdominal Operations. 2007: 8: 48-850.5. Zuidema D. Yeo Ch.J. Surgery of the Alimentary

Tract, Fifth Edition, Volume III. 144-150.6. Couinaud C. Le foic etudes anatomiques et

chirurgicales. 1957: 119-135.7. Dracini X. Variacionet anatomike te rrugëve bil-

iare dhe pasojat kirurgjike te tyre. Monography. Univerity of Tirana. 2011. 22-38; 143-154.

Tab. 1. CD-CHD junction distribution in all patients.

It is important to notice that Lower Left union is present in 14.18% of patients.

Tab. 2. CD-CHD junction distribution in male patients.

Figure 2. CD-CHD junction distribution in male patients.

Right CD-CHD junction in male was in 79.81% of patients and left junction in 19.45% of

patients.

Tab. 3. CD-CHD junction distribution in female patients.

Right CD-CHD junction in female was in 77.62% of patients and left junction in 19.45% of

patients.

There is deference between male and female in lower CD-CHD junction (p<0.01), and there is

also deference between male and female in left lower CD-CHD junction (p<0.05)

4. CONCLUSIONS

We conclude that CD-CHD junction was identified as right junction in 79.05% patients and as

left CD-CHD junction was identified in 20.95%. We haven’t find significant differences between

male and female groups according to right or left CD-CHD junction (p<0.05). There is deference

between male and female in left lower CD-CHD junction (p<0.01). We have identified LL CD-

CHD junction in 14.18% of patients and that is rare prescribed in literature.

Figure 3. CD-CHD junction distribution in female patients.