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Anatomical variations of liver blood supply in patients with pancreaticobiliary maljunction

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Abstract

Purpose

Pancreaticobiliary maljunction (PBM) arises from a developmental abnormality during the embryonic period; thus, these patients may have anatomical variations of the liver blood supply, including aberrant vessels and unusual locations.

Methods

We reviewed retrospectively the vascular anatomy of 52 patients with PBM, who were seen between 1998 and 2013.

Results

There were 11 male patients and 41 female patients. Sixteen patients had bile duct type (C–P type) PBM, 35 had pancreatic duct type (P–C type) PBM, and one had complex type PBM. Thirty-three patients had biliary dilatation. Nine (17.3 %) patients had an aberrant (replaced or accessory) hepatic artery and 2 (3.8 %) had an aberrant portal vein. Among 39 patients evaluated by contrast-enhanced computed tomography, 8 (20.5 %) had their right hepatic artery positioned on the ventral side of the common bile duct. The presence of aberrant hepatic vessels was not related to the type of confluence, biliary dilatation, type of Todani classification, or associated biliary malignancies.

Conclusions

The incidence of the right hepatic artery being located on the ventral side of the common bile duct may be higher in patients with PBM than the naturally occurring incidence of about 10 % in the general Japanese population.

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References

  1. Kamisawa T, Ando H, Suyama M, Shimada M, Morine Y, Shimada H. Japanese clinical practice guidelines for pancreaticobiliary maljunction. J Gastroenterol. 2012;47:731–59.

    Article  PubMed  Google Scholar 

  2. Ando H, Kaneko K, Ito F, Seo T, Harada T, Watanabe Y. Embryogenesis of pancreaticobiliary maljunction inferred from development of duodenal atresia. J Hepatobiliary Pancreat Surg. 1999;6:50–4.

    Article  CAS  PubMed  Google Scholar 

  3. Funabiki T, Sugiue K, Matsubara T, Amano H, Ochiai M. Bile acids and biliary carcinoma in pancreaticobiliary maljunction. Keio J Med. 1991;40:118–22.

    Article  CAS  PubMed  Google Scholar 

  4. Kaneko K, Ando H, Ito T, Kasai K, Watanabe Y, Seo T. Increased cell proliferation and transforming growth factor-alpha (TGF alpha) in the gall-bladder epithelium of patients with pancreaticobiliary maljunction. Pathol Int. 1996;46:253–60.

    Article  CAS  PubMed  Google Scholar 

  5. Matsubara T, Sakurai Y, Sasayama Y, Hori H, Ochiai M, Funabiki T, et al. K-ras point mutations in cancerous and noncancerous biliary epithelium in patients with pancreaticobiliary maljunction. Cancer. 1996;77:1752–7.

    Article  CAS  PubMed  Google Scholar 

  6. Mizuno M, Kato T, Koyama K. An analysis of mutagens in the contents of the biliary tract in pancreaticobiliary maljunction. Surg Today. 1996;26:597–602.

    Article  CAS  PubMed  Google Scholar 

  7. Horaguchi J, Fujita N, Kamisawa T, Honda G, Chijiiwa K, Maguchi H, et al. Pancreatobiliary reflux in individuals with a normal pancreaticobiliary junction: a prospective multicenter study. J Gastroenterol. 2013.

  8. Morine Y, Shimada M, Takamatsu H, Araida T, Endo I, Kubota M, et al. Clinical features of pancreaticobiliary maljunction: update analysis of 2nd Japan-nationwide survey. J Hepatobiliary Pancreat Sci. 2013;20:472–80.

    Article  PubMed  Google Scholar 

  9. Funabiki T, Matsubara T, Ochiai M, Marugami Y, Sakurai Y, Hasegawa S, et al. Surgical strategy for patients with pancreaticobiliary maljunction without choledocal dilatation. Keio J Med. 1997;46:169–72.

    Article  CAS  PubMed  Google Scholar 

  10. Kobayashi S, Asano T, Yamasaki M, Kenmochi T, Saigo K, Ochiai T. Prophylactic excision of the gallbladder and bile duct for patients with pancreaticobiliary maljunction. Arch Surg. 2001;136:759–63.

    Article  CAS  PubMed  Google Scholar 

  11. Kobayashi S, Ohnuma N, Yoshida H, Ohtsuka Y, Terui K, Asano T, et al. Preferable operative age of choledochal dilation types to prevent patients with pancreaticobiliary maljunction from developing biliary tract carcinogenesis. Surgery. 2006;139:33–8.

    Article  PubMed  Google Scholar 

  12. Sakaguchi T, Suzuki S, Hiraide T, Shibasaki Y, Morita Y, Suzuki A, et al. Anomalous arterial ramification in the right liver. Surg Today. 2013;43:1269–74.

    Article  PubMed  Google Scholar 

  13. Gruttadauria S, Foglieni CS, Doria C, Luca A, Lauro A, Marino IR. The hepatic artery in liver transplantation and surgery: vascular anomalies in 701 cases. Clin Transplant. 2001;15:359–63.

    Article  CAS  PubMed  Google Scholar 

  14. Michels NA. Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg. 1966;112:337–47.

    Article  CAS  PubMed  Google Scholar 

  15. Hiatt JR, Gabbay J, Busuttil RW. Surgical anatomy of the hepatic arteries in 1000 cases. Ann Surg. 1994;220:50–2.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  16. Kamisawa T, Ando H, Hamada Y, Fujii H, Koshinaga T, Urushihara N, et al. Diagnostic criteria for pancreaticobiliary maljunction 2013. J Hepatobiliary Pancreat Sci. 2014;21:159–61.

    Article  PubMed  Google Scholar 

  17. Baba Y, Hokotate H, Nishi H, Inoue H, Nakajo M. Intrahepatic portal venous variations: demonstration by helical CT during arterial portography. J Comput Assist Tomogr. 2000;24:802–8.

    Article  CAS  PubMed  Google Scholar 

  18. Todani T. Congenital choledochal dilatation: classification, clinical features, and long-term results. J Hepatobiliary Pancreat Surg. 1997;4:276–82.

    Article  Google Scholar 

  19. Moszkowicz D, Peschaud F, El Hajjam M, Saiag P, Nordlinger B. Preservation of an intra-pancreatic hepatic artery during duodenopancreatectomy for melanoma metastasis. Surg Radiol Anat. 2011;33:547–50.

    Article  PubMed  Google Scholar 

  20. Tashiro S, Imaizumi T, Ohkawa H, Okada A, Katoh T, Kawaharada Y, et al. Pancreaticobiliary maljunction: retrospective and nationwide survey in Japan. J Hepatobiliary Pancreat Surg. 2003;10:345–51.

    Article  PubMed  Google Scholar 

  21. Murakami S, Ajiki T, Okazaki T, Ueno K, Kido M, Matsumoto I, et al. Factors affecting survival after resection of intrahepatic cholangiocarcinoma. Surg Today. 2014;44:1847–54.

    Article  PubMed  Google Scholar 

  22. Sahani D, Mehta A, Blake M, Prasad S, Harris G, Saini S. Preoperative hepatic vascular evaluation with CT and MR angiography: implications for surgery. Radiographics. 2004;24:1367–80.

    Article  PubMed  Google Scholar 

  23. Chaib E, Ribeiro MA Jr, Saad WA, Gama-Rodrigues J. The main hepatic anatomic variations for the purpose of split-liver transplantation. Transplant Proc. 2005;37:1063–6.

    Article  CAS  PubMed  Google Scholar 

  24. Kanamori Y, Sato K, Yamada K, Yamada W, Kitami M. A case of absence of extrahepatic portal bifurcation in biliary atresia. J Pediatr Surg. 2013;48:e29–31.

    Article  PubMed  Google Scholar 

  25. Radtke A, Sgourakis G, Sotiropoulos GC, Molmenti EP, Nadalin S, Fouzas I, et al. Hepatic hilar and sectorial vascular and biliary anatomy in right graft adult live liver donor transplantation. Transplant Proc. 2008;40:3147–50.

    Article  CAS  PubMed  Google Scholar 

  26. Sakai H, Okuda Y, Goto Y, Kinoshita H, Aoyagi N. Anatomic variations of segmental hepatic artery at hepatic hilar area-analysis by 3 dimentional integrated image of artery, portal vein and bile duct (in Japanese). Tan to Sui. 2010;31:681–8.

    Google Scholar 

  27. Suzuki H. Correlation and anomalies of the vascular structure in Glisson’s area around the hepatic hilum, from the standpoint of hepatobiliary surgery (in Japanese). Nihon geka hokan Archiv fur japanische Chirurgie. 1982;51:713–31.

    CAS  PubMed  Google Scholar 

  28. Weiglein AH. Variations and topography of the arteries in the lesser omentum in humans. Clin Anat. 1996;9:143–50.

    Article  CAS  PubMed  Google Scholar 

  29. Slack JM. Developmental biology of the pancreas. Development. 1995;121:1569–80.

    CAS  PubMed  Google Scholar 

  30. Sadler TW. Digestive system In: Langman’s medical embryology. 12th ed. Philadelphia: Lippincott Williams & Wilkins, p. 208–225.

  31. Douard R, Chevallier JM, Delmas V, Cugnenc PH. Clinical interest of digestive arterial trunk anastomoses. Surg Radiol Anat. 2006;28:219–27.

    Article  PubMed  Google Scholar 

  32. Narita T, Ishii Y, Nohno T, Noji S, Yasugi S. Sonic hedgehog expression in developing chicken digestive organs is regulated by epithelial-mesenchymal interactions. Dev Growth Differ. 1998;40:67–74.

    Article  CAS  PubMed  Google Scholar 

  33. Pola R, Ling LE, Silver M, Corbley MJ, Kearney M, Blake Pepinsky R, et al. The morphogen Sonic hedgehog is an indirect angiogenic agent upregulating two families of angiogenic growth factors. Nat Med. 2001;7:706–11.

    Article  CAS  PubMed  Google Scholar 

  34. Komuro H, Gotoh C, Urita Y, Fujishiro J, Shinkai T. A pediatric case of an unusual type of annular pancreas presenting with duodenopancreatic reflux. Pediatr Surg Int. 2012;28:715–7.

    Article  PubMed  Google Scholar 

  35. Terui K, Hishiki T, Saito T, Sato Y, Takenouchi A, Saito E, et al. Pancreas divisum in pancreaticobiliary maljunction in children. Pediatr Surg Int. 2010;26:419–22.

    Article  PubMed  Google Scholar 

  36. Zhang Y, Sun W, Zhang F, Huang J, Fan Z. Pancreaticobiliary maljuction combining with pancreas divisum: report of four cases. Exp Ther Med. 2014;7:8–10.

    PubMed Central  PubMed  Google Scholar 

  37. Chen G, Wang H, Zhang L, Li Z, Bie P. Double common bile duct with choledochal cyst and cholelithiasis: report of a case. Surg Today. 2014;44:778–82.

    Article  PubMed  Google Scholar 

  38. Tahara K, Ishimaru Y, Fujino J, Suzuki M, Hatanaka M, Igarashi A, et al. Association of extrahepatic bile duct duplication with pancreaticobiliary maljunction and congenital biliary dilatation in children: a case report and literature review. Surg Today. 2013;43:800–5.

    Article  PubMed  Google Scholar 

  39. Yamashita K, Oka Y, Urakami A, Iwamoto S, Tsunoda T, Eto T. Double common bile duct: a case report and a review of the Japanese literature. Surgery. 2002;131:676–81.

    Article  PubMed  Google Scholar 

  40. Boyden EA. The problem of the double ductus choledochus (an interpretation of an accessory bile duct found attached to the pars superior of the duodenum). Anat Rec. 1932;55:71–93.

    Article  Google Scholar 

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Conflict of interest

Kenta Shinozaki and his co-authors have no conflicts of interest.

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Authors and Affiliations

  1. Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-Ku, Kobe, Japan

    Kenta Shinozaki, Tetsuo Ajiki, Taku Matsumoto, Yuko Yoshida, Sae Murakami, Taro Okazaki, Hirochika Toyama, Ippei Matsumoto, Takumi Fukumoto & Yonson Ku

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  1. Kenta Shinozaki
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  2. Tetsuo Ajiki
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  3. Taku Matsumoto
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  4. Yuko Yoshida
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  5. Sae Murakami
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  6. Taro Okazaki
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  7. Hirochika Toyama
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  9. Takumi Fukumoto
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  10. Yonson Ku
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Correspondence to Tetsuo Ajiki.

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Shinozaki, K., Ajiki, T., Matsumoto, T. et al. Anatomical variations of liver blood supply in patients with pancreaticobiliary maljunction. Surg Today 46, 169–175 (2016). https://doi.org/10.1007/s00595-015-1118-2

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  • DOI: https://doi.org/10.1007/s00595-015-1118-2

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