Illustrated Encyclopedia of Human Anatomic Variation: Opus II: Cardiovascular System
Ronald A. Bergman, PhD
Adel K. Afifi, MD, MS
Ryosuke Miyauchi, MD
Peer Review Status: Internally Peer Reviewed
RHA, Right hepatic artery; LHA, left hepatic artery; HPA, main hepatic artery; CHA, common hepatic trunk; GDA, gastroduodenal artery; CA, cystic artery; HD, main hepatic duct; CD, cystic duct; CBD, common bile duct; SPDA, superior pancreatoduodenal artery.
E: Various modes of origin of double cystic arteries. 1: In 8% of the cases having two cystic arteries, both vessels arise from the right hepatic artery.
2: In 2% one artery arises from the right hepatic artery.
3: In 1% one artery arises from the right hepatic and the other from the main hepatic (hepatica propria) artery.
4: In 1% both vessels arise from the right hepatic artery.
F: Variations in the mode of union of the cystic and main hepatic ducts. 1: Normal (75%) unite at acute angle. Terminal 2 cm paralleled and held together firmly by fibrous tissue.
2: Short parallel type. Parallel for 5 cm or more as far as upper border of pancreas.
3: Long parallel type. Parallel almost throughout course, i.e., to within 1/2--l cm from ampulla of Vater.
2, 3: Together occurred in 17%.
4, 5: Anterior and posterior spiral types occurred in 8%. Note how cystic duct winds around anterior (or posterior) surface of the hepatic duct to enter its left border.
G: Anomalies in the right hepatic duct. 1: Right hepatic duct empties into cystic duct.
2: Cystic duct empties into the right hepatic duct.
H: Possible locations of calculi in cases with anomalies of the mode of union of the cystic and hepatic ducts. 1: Calculus in cystic duct of short parallel type. Can compress hepatic duct and cause same symptom as calculus in that duct.
2: Calculi in long parallel type of ducts. Could cause great technical difficulty in removal, with possible injury of ducts.
3: Calculi in spiral cystic duct. Very puzzling clinical picture if one (single arrow) compressed hepatic duct and other obstructed a cystic duct (double arrow) emptying into hepatic duct on its left side.
4: Similar possibilities from clinical and operative standpoint as in 3.
Redrawn from Eisendrath, D.N. The clinical importance of anatomical anomalies in biliary surgery. Boston Med. Surg. J. 182:573-578, 1920.
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