Anatomical variations of the hepatobiliary system in Sudanese patients undergoing endoscopic retrograde cholangiopancreatography (ERCP)

  • Authors

    • Wael Doush University of KhartoumAssistant Professor of General SurgeryMRCSEd.-Clinical MD
    • Mohammed A-Galil University of Khartoum
    • Shakir Ibrahim University of Khartoum
    2017-04-02
    https://doi.org/10.14419/ijm.v5i1.7394
  • Ampulla of Vater, Anatomy, Congenital Variations, Choledochal Cyst, Cystic Duct, Endoscopic Retrograde Cholangiopancreatography, Sudan.

  • Abstract

    Background: The meticulous identification of the hepatobiliary tree system normal anatomy during surgical operations is crucial in iatrogenic injury prevention. Equally important, an understanding of the congenital variations of biliary and vascular anatomy, as the literature abounds with reports of specific anatomical variations, and their surgical implications.

    Aim: This study aimed to study the presence of anatomical variations within the hepatobiliary system in Sudanese population undergoing endoscopic retrograde cholangiopancreatography (ERCP).

    Patients and methods: The records of patients undergoing ERCP in Soba University Hospital during 2004 to 2008 were analyzed. There were 277 Sudanese patients who had complained of right hypochondrial abdominal pain & history of jaundice (obstructive jaundice) that underwent ERCP were included within this study. The exclusion criteria included the following: Sudanese patients in whom ERCP failed or patients who had advanced hepatobiliary disease like cancers, strictures either cancerous or iatrogenic, fistula and iatrogenic biliary leak.

    Results: The analysis of 277 Sudanese patients undergoing ERCP of the hepatobiliary system showed the following results regarding the variations: The choledochal cyst type one (fusiform type) was present in 3 (1.08%) patients; very low cystic duct insertion (parallel) was present in 1 (0.36%) patient and long cystic duct was present in 3 (1.08%) patients. The ampulla of Vater size variations occurred as A) Normal in 158 (57%) patient, B) Small in 56 (20.2%) patients, C) Large in 29 (10.5%) patients, D) Periampullary diverticula in 4 (1.4%) patients and E) unclassified in 30 (10.8%) patients. Other forms of congenital anomalies were not found.

    Conclusion: The using of endoscopic retrograde cholangiopancreatography (ERCP) is a reliable radiological method for depicting congenital anomalies of the hepatobiliary system, but it is an invasive procedure.

    Author Biography

    • Wael Doush, University of KhartoumAssistant Professor of General SurgeryMRCSEd.-Clinical MD

      1-General Surgery articles.

      2-Gastrointestinal Surgery articles.

      3-Hepatobiliary Surgery and Liver transplantation articles.

       

  • References

    1. [1] Williams, PL., 1980. Gray's Anatomy (36th ed). New York: Churchill Livingstone, pp. 1374- 1385.

      [2] Nayman, A., Özbek, O., Erol, S., Karakuş, H. and Kaya, H.E., 2016. Magnetic resonance cholangiopancreatography evaluation of intrahepatic bile duct variations with updated classification. Diagnostic and Interventional Radiology, 22(6), p.489. https://doi.org/10.5152/dir.2016.16051.

      [3] Leung, J., 2005. Fundamentals of ERCP. Advanced Digestive Endoscopy: ERCP. Blackwell Science, p.1.

      [4] Ahmad, M.A. Khan, N.M. and Asmatullah., 2016. Anatomical variations of hepatobiliary triangle in patients operated laparoscopically for gallbladder diseases from Lahore and Sahiwal. Punjab Univ. J.Zool., 31(1):pp.47-52. DOI:40-PUJZ-61023120/16/0047-0052

      [5] Y. K., Sarin, C. S., Sharma, L.D., Agarwal, M. Zaffar and A.K. Sharma., 1994 Choledochal Cyst. Pediatric Surgery Giant, 31, pp. 215-217.

      [6] Lamah, M., Karanjia, N.D. and Dickson, G.H., 2001. Anatomical variations of the extrahepatic biliary tree: review of the world literature. Clinical anatomy, 14(3), pp.167-172. https://doi.org/10.1002/ca.1028.

      [7] Kim, H.J., Kim, M.H., Lee, S.K., Seo, D.W., Kim, Y.T., Lee, D.K., Song, S.Y., Roe, I.H., Kim, J.H., Chung, J.B. and Kim, C.D., 2002. Normal structure, variations, and anomalies of the pancreaticobiliary ducts of Koreans: a nationwide cooperative prospective study. Gastrointestinal endoscopy, 55(7), pp.889-896. https://doi.org/10.1067/mge.2002.124635.

      [8] Myles, R.B., 1937. Anatomical Variations of the Stomach and Duodenum within the Abdominal Cavity. The British Journal of Radiology, 10(111), pp.237-260. https://doi.org/10.1259/0007-1285-10-111-237.

      [9] Lipsett, P.A., Segev, D.L. and Colombani, P.M., 1997. Biliary atresia and biliary cysts. Baillière's clinical gastroenterology, 11(4), pp.619-641. https://doi.org/10.1016/S0950-3528(97)90013-0.

      [10] Ishibashi, T., Kasahara, K., Yasuda, Y., Nagai, H., Makino, S. and Kanazawa, K., 1997. Malignant change in the biliary tract after excision of choledochal cyst. British journal of Surgery, 84(12), pp.1687-1691. https://doi.org/10.1046/j.1365-2168.1997.02843.x.

      [11] Keddie, N.C., Taylor, A.W. and Sykes, P.A., 1974. The termination of the common bile duct. British Journal of Surgery, 61(8), pp.623-625. https://doi.org/10.1002/bjs.1800610808.

      [12] Davenport, M., Heaton, N.D. and Howard, E.R., 1991. Spontaneous perforation of the bile duct in infants. British journal of surgery, 78(9), pp.1068-1070. https://doi.org/10.1002/bjs.1800780912.

      [13] Jong Ho Chun, 1997. A study of 162 cases of prei ampullary diverticulum. Korean J gastrointest endosc. 17, pp.778-788.

  • Downloads

  • How to Cite

    Doush, W., A-Galil, M., & Ibrahim, S. (2017). Anatomical variations of the hepatobiliary system in Sudanese patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). International Journal of Medicine, 5(1), 105-108. https://doi.org/10.14419/ijm.v5i1.7394

    Received date: 2017-02-21

    Accepted date: 2017-03-26

    Published date: 2017-04-02