Accessory bile duct

Accessory bile duct

Anatomical terminology

An accessory bile duct is a conduit that transports bile and is considered to be supernumerary or auxiliary to the biliary tree.[1]

It may be described by its location relative to the gallbladder as supravesicular[2][3] (superior to the gallbladder body) or subvesicular[4][5] (inferior to the gallbladder body).

Duct of Luschka

In the surgical literature, the term duct of Luschka is used to refer to an accessory bile duct. They are small ducts that distinctly enter the gallbladder bed, or small tributaries of minor intrahepatic radicals of the right hepatic ductal system.[6] They can drain directly from the liver into the body of the gallbladder.[7] They may not always drain bile and sometimes can have blind distal ends.[2] One study showed them originating from the liver parenchyma of the right anterior inferior dorsal subsegment or from the connective tissue of the gallballder bed. The study showed the distal connections ending at the hepatic right anterior inferior dorsal branch, hepatic right anterior branch, right hepatic duct, or common hepatic duct.[8]

The term duct of Luschka is ambiguous, as it may refer to supravesicular[2][3] or subvesicular ducts.[4][5] Supravesicular ducts are typically in the gallbladder bed. A 2012 review suggested that the term duct of Luschka should be abandoned because of this ambiguity and replaced by the more specific term subvesical bile duct.[9] As well, the exact origin and drainage locations of the relevant duct(s) varied greatly between patients.

Of 116 articles, 54 provided detailed anatomic information identifying 238 subvesical ducts, most of which represented accessory ducts. The origin and drainage of these ducts were limited primarily to the right lobe of the liver, but great variation was seen.
— -Schnelldorfer et al., [9]

Clinical significance

Although they may not drain any liver parenchyma, they can be a source of a bile leak or biliary peritonitis after cholecystectomy in both adults and children. If an accessory bile duct goes unrecognized at the time of the gallbladder removal, 5–7 days post-operative the patient will develop bile peritonitis, an easily treatable complication with a morbidity rate of 44% if left untreated.

Often diagnosed by HIDA scan, a bile leak from an accessory bile duct post-op can be treated with a temporary biliary stent to redirect the bile from the liver into the intestine and allow the accessory duct to spontaneously seal itself.

Eponym

The term is named after German anatomist Hubert von Luschka (1820-1875)[10][11] who described the first case in 1863.[8]

References

  1. ↑ Strasberg, Steven M.; Hawkins, William (2006). "Reconstruction of the Bile Duct: Anatomic Principles and Surgical Techniques". In Fischer, Josef E.; Bland, Kirby I.; Caller, Mark P. Mastery of Surgery. Lippincott Williams & Wilkins. pp. 1129–42. ISBN 978-0-7817-7165-8.
  2. 1 2 3 Sharif, K; De Ville De Goyet, J (2003). "Bile duct of luschka leading to bile leak after cholecystectomy—revisiting the biliary anatomy". Journal of Pediatric Surgery 38 (11): E21–3. doi:10.1016/j.jpedsurg.2003.08.008. PMID 14614740.
  3. 1 2 McQuillan, T.; Manolas, S. G.; Hayman, J. A.; Kune, G. A. (1989). "Surgical significance of the bile duct of Luschka". British Journal of Surgery 76 (7): 696–8. doi:10.1002/bjs.1800760715. PMID 2765803.
  4. 1 2 Ko, Kenju; Kamiya, Junichi; Nagino, Masato; Oda, Koji; Yuasa, Norihiro; Arai, Toshiyuki; Nishio, Hideki; Nimura, Yuji (2006). "A Study of the Subvesical Bile Duct (Duct of Luschka) in Resected Liver Specimens". World Journal of Surgery 30 (7): 1316–20. doi:10.1007/s00268-005-0469-z. PMID 16830216.
  5. 1 2 Spanos, Constantine P.; Syrakos, Theodore (2006). "Bile leaks from the duct of Luschka (subvesical duct): A review". Langenbeck's Archives of Surgery 391 (5): 441–7. doi:10.1007/s00423-006-0078-9. PMID 16927110.
  6. ↑ http://www.uptodate.com/contents/complications-of-laparoscopic-cholecystectomy?detectedLanguage=en&source=search_result&search=luschka&selectedTitle=1~12&provider=noProvider[]
  7. ↑ http://accessmedicine.com/content.aspx?aID=5026669[]
  8. 1 2 Ko, Kenju; Kamiya, Junichi; Nagino, Masato; Oda, Koji; Yuasa, Norihiro; Arai, Toshiyuki; Nishio, Hideki; Nimura, Yuji (2006). "A Study of the Subvesical Bile Duct (Duct of Luschka) in Resected Liver Specimens". World Journal of Surgery 30 (7): 1316–20. doi:10.1007/s00268-005-0469-z. PMID 16830216.
  9. 1 2 Schnelldorfer, Thomas; Sarr, Michael G.; Adams, David B. (2012). "What is the Duct of Luschka?—A Systematic Review". Journal of Gastrointestinal Surgery 16 (3): 656–62. doi:10.1007/s11605-011-1802-5. PMID 22215244.
  10. ↑ Bátorfi, J; Baranyay, F; Simon, E; Beznicza, H; Kolonics, G (2004). "Luschka-jarati epecsorgas laparoszkopos ellatasa laparoszkopos cholecystectomia utan" [Laparoscopic treatment of bile leakage from the Luschka duct after laparoscopic cholecystectomy]. Orvosi hetilap (in Hungarian) 145 (20): 1061–4. PMID 15202328.
  11. ↑ Luschka's ducts at Who Named It?
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