Variant anatomy of structures in Calot’s triangle
https://doi.org/10.34215/1609-1175-2024-1-24-28
Abstract
The variant anatomy of the biliary tract and its sources of blood supply causes technical difficulties and increases the risk of damage to these main structures in the area of the porta hepatis and hepatoduodenal ligament during hepatobiliary operations, especially laparoscopic cholecystectomy. The main structures form a single topographic formation – the Calot’s triangle, with possible multiple anatomical variations, considered in the literature review.
About the Authors
A. N. ShilovaRussian Federation
Moscow
T. S. Zharikova
Russian Federation
Moscow
K. R. Koychuev
Russian Federation
Moscow
Yu. O. Zharikov
Russian Federation
Yury O. Zharikov, Cand. Sci. (Med.), Associate Professor, Department of Human Anatomy and Histology, Institute of clinical medicine
11 Mokhovaya str., p. 10, Moscow, 125009
V. N. Nikolenko
Russian Federation
Moscow
References
1. Belous PV. Variant anatomy of the artery of the liver and its ductal system. Journal of the Grodno State Medical University. 2014;3(47):117–22 (In Russ.)
2. Alvarez FA, de Santibañes M, Palavecino M, Sánchez Clariá R, Mazza O, Arbues G, de Santibañes E, Pekolj J. Impact of routine intraoperative cholangiography during laparoscopic cholecystectomy on bile duct injury. Br J Surg. 2014;101(6):677–84. DOI: 10.1002/bjs.9486
3. Fomov GV, Muhin AS, Podolinnyj GI, Gorpinyuk VP, Zvyagincev VV. Markers of anomalies of Calot’s triangle anatomy. Medicinskij Almanah. 2011;(2):58–61 (In Russ.)
4. Köckerling F, Schneider C, Reymond MA, Hohenberger W. Laparoskopische Cholezystektomie in anterograder (prograder) Technik [Laparoscopic cholecystectomy in antegrade (prograde) technique]. Zentralbl Chir. 1997;122(6):498–500.
5. Batalova YuS, Efremov SS. Variant anatomy of the structures of Calot’s triangle. Almanah Molodoj Nauki. 2015;3:20–3 (In Russ.)
6. Belous PV. Variant anatomy of the blood supply of the right lobe of the liver. Journal of the Grodno State Medical University. 2013;3(43):58–61 (In Russ.)
7. Suzuki M, Akaishi S, Rikiyama T, Naitoh T, Rahman MM, Matsuno S. Laparoscopic cholecystectomy, Calot’s triangle, and variations in cystic arterial supply. Surg Endos. 2000;14(2):141–4. doi: 10.1007/s004649900086
8. Abdalla S, Pierre S, Ellis H. Calot’s triangle. Clin Anat. 2013;26(4):493–501. doi: 10.1002/ca.22170
9. Teremov SA, Mukhin AS, Gradusov VP. Calot’s triangle rare anomaly during laparoscopic cholecystectomy. Endoscopic Surgery. 2011;17(2):12–3 (In Russ.)
10. Zharikov YuO, Kovalenko YuA, Zharikova TS, Shkerdina MI, Nikolenko VN. Surgical anatomy of liver segment IV and its importance in hepatobiliary surgery. Pirogov Russian Journal of Surgery = Khirurgiya. Zhurnal im. N.I. Pirogova. 2019;(11):93–9 (In Russ.) doi: 10.17116/hirurgia201911193
11. Belous PV. Variant anatomy of the cystic artery and cystic duct. Health and Ecology Issues. 2014;2(40):70–6 (In Russ.)
12. D’Angelo T, Racchiusa S, Mazziotti S, Cicero G. Magnetic Resonance (MR) Cholangiopancreatography Demonstration of the Cystic Duct Entering the Right Hepatic Duct. Am J Case Rep. 2017;18:242–5. doi: 10.12659/ajcr.902620
13. Nomura T, Shirai Y, Sasagawa M, Wakai T, Hatakeyama K. Anomalous insertion of the right hepatic duct into the cystic duct: report of a case diagnosed before laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech. 1999;9(3):211212.
14. Abe T, Ito S, Kaneda Y, Suto R, Noshima S. Main right hepatic duct entering the cystic duct: a case report. Surg Case Rep. 2019;5(1):46. doi: 10.1186/s40792-019-0604-y.
15. Tsutsumi S, Hosouchi Y, Shimura T, Asao T, Kojima T, Takenoshita S, Kuwano H. Double cystic duct detected by endoscopic retrograde cholangiopancreatography and confirmed by intraoperative cholangiography in laparoscopic cholecystectomy: a case report. Hepatogastroenterology. 2000;47(35):1266–8.
16. Munie S, Nasser H, Go PH, Rosso K, Woodward A. Case report of a duplicated cystic duct: A unique challenge for the laparoscopic surgeon. Int J Surg Case Rep. 2019;56:78–81. doi: 10.1016/j.ijscr.2019.02.030
17. Balija M, Huis M, Szerda F, Bubnjar J, Stulhofer M. Laparoskopska kolecistektomija-akcesorni zucni vodovi [Laparoscopiccholecystectomy-accessory bile ducts]. Acta Med Croatica. 2003;57(2):105–9.
18. Itoh T, Fuji N, Taniguchi H, Yasukawa S, Yasuda H, Wakabayashi N, Watanabe T, Kosuga T, Kashimoto K, Yanagisawa A, Naito K. Double cancer of the cystic duct and gallbladder associated with low junction of the cystic duct. J Hepatobiliary Pancreat Surg. 2008; 15(3):338–343. doi: 10.1007/s00534-007-1245-2
19. Mugunthan N, Kannan R, Jebakani CF, Anbalagan J. Variations in the Origin and Course of Right Hepatic Artery and its Surgical Significance. J Clin Diagn Res. 2016;10(9):AC01–AC04. doi: 10.7860/JCDR/2016/22126.8428
20. Asghar A, Priya A, Patra A, Gupta P, Kumar A. Moynihan’s hump of the right hepatic artery in Calot’s triangle: a systematic review and meta-analysis of its incidence and surgical importance. Surg Radiol Anat. 2023;45(5):643–651. doi: 10.1007/s00276-023-03125-8
21. Raghuwanshi DS, Ram M, Khan S, Anand K. Moynihan’s Hump: Our Eyes See What Our Mind Knows. Indian J Surg. 2021; 83, 1077–1078. doi: 10.1007/s12262-020-02535-x
22. Marano L, Bartoli A, Polom K, Bellochi R, Spaziani A, Castagnoli G. The unwanted third wheel in the Calot’s triangle: Incidence and surgical significance of caterpillar hump of right hepatic artery with a systematic review of the literature. J Minim Access Surg. 2019;15(3):185–91. doi: 10.4103/jmas.JMAS_75_18.
23. Kavitha Kamath B. An anatomical study of Moynihan’s hump of right hepatic artery and its surgical importance. Journal of the Anatomical Society of India. 2016;65(Supp.1):65–7. doi: 10.1016/j.jasi.2016.04.004.
24. Balija M, Huis M, Nikolic V, Stulhofer M. Laparoscopic visualization of the cystic artery anatomy. World J Surg. 1999;23(7):703–7. doi: 10.1007/pl00012372
25. Hugh TB, Kelly MD, Li B. Laparoscopic anatomy of the cystic artery. Am J Surg. 1992;163(6):593–5. doi: 10.1016/0002-9610(92)90564-8
26. Ding YM, Wang B, Wang WX, Wang P, Yan JS. New classification of the anatomic variations of cystic artery during laparoscopic cholecystectomy. World J Gastroenterol. 2007;13(42):56295634. doi: 10.3748/wjg.v13.i42.5629
27. Chetan S, R ajesh K. Cholec ysto-colic Ligament – Anatomical, Physiological and Clinical Prospect. Journal of Morphological Sciences. 2022;39:494–7. doi: 10.51929/jms.39.494.2022
28. Andall RG, Matusz P, du Plessis M, Ward R, Tubbs RS, Loukas M. The clinical anatomy of cystic artery variations: a review of over 9800 cases. Surg Radiol Anat. 2016;38(5):529–39. doi: 10.1007/s00276-015-1600-y
29. Flisiński P, Szpinda M, Flisiński M. The cystic artery in human foetuses. Folia Morphol (Warsz). 2004;63(1):47–50.
30. Tantia O, Jain M, Khanna S, Sen B. Post cholecystectomy syndrome: Role of cystic duct stump and re-intervention by laparoscopic surgery. J Minim Access Surg. 2008;4(3):71–5. doi: 10.4103/0972-9941.43090
31. Yamashita K, Hashimoto D, Itoyama R, Okabe H, Chikamoto A, Beppu T, Baba H. Accessory right hepatic artery branched from gastroduodenal artery. Surg Case Rep. 2015;1:90. doi: 10.1186/s40792-015-0092-7
Review
For citations:
Shilova A.N., Zharikova T.S., Koychuev K.R., Zharikov Yu.O., Nikolenko V.N. Variant anatomy of structures in Calot’s triangle. Pacific Medical Journal. 2024;(1):24-28. (In Russ.) https://doi.org/10.34215/1609-1175-2024-1-24-28