Couinaud Type A communicating accessory bile duct: report of a case
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ANATOMIC VARIATIONS
Couinaud Type A communicating accessory bile duct: report of a case Atsushi Shimizu1 · Alan Kawarai Lefor1 · Yasuko Noda2 · Naohiro Sata1 Received: 11 June 2020 / Accepted: 11 July 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Background Communicating accessory bile ducts are defined as ducts that communicate between major biliary channels but do not drain individual segments of the liver. The Couinaud Type A communicating accessory bile duct is a rare anomaly where an aberrant duct connects the right main hepatic duct to the common hepatic duct without segmental drainage. There are very few reports of this anomaly in the literature to date. Case presentation A 75-year-old male who died of ischemic heart disease donated his body for cadaveric dissection, which included careful attention to the anatomy of the hepatic hilum. During dissection, it was found that the right hepatic duct was duplicated and an accessory duct drained directly into the common hepatic duct. Although rare and difficult to visualize even with modern preoperative imaging techniques, sound knowledge of this rare anatomic variation is imperative to avoid inadvertent intraoperative biliary injuries which can lead to severe morbidity. Conclusions An aberrant bile duct from the right hepatic duct to the common hepatic duct (Couinaud Type A) is an uncommon accessory bile duct that one must be aware of when performing complex hepatobiliary procedures such as right liver resection for living-related donation. Detailed preoperative imaging and careful dissection with anticipation of anomalous anatomy are of the utmost importance for the safe conduct of hepatic surgery. Keywords Communicating accessory bile duct
Background Goor classified anomalies of the biliary tree and defined communicating accessory bile ducts as ducts that communicate between major biliary channels but do not drain individual segments of the liver [5]. These anomalies are categorized into four groups, from F1 to F4, including F1-connecting the right anterior and posterior branches, F2-connecting the right hepatic duct and cystic duct; * Atsushi Shimizu [email protected]
F3-between the right hepatic duct and the neck of the gallbladder, and F4-between two lobes (these four correspond to the Couinaud Types B, C, D and E). Based on Mizumoto’s report, Couinaud re-classified communicating accessory bile ducts into five types, Types A through E, adding a fifth category to the previous four described by Goor, the “Type A”, where an aberrant duct connects the right main hepatic duct to the common hepatic duct without segmental drainage [2, 7]. To date, however, few of these have been reported in the literature. We present a rare case of a Couinaud Type A communicating accessory bile duct.
Alan Kawarai Lefor [email protected]
Case presentation
Yasuko Noda [email protected]
A 75-year-old male who died of ischemic heart disease donated his body for cadaveric dissection. During careful dissection of the hepatic hilum, it was fou
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