Low Insertion of the Cystic Duct in the Common Hepatic Duct as a Coincidence with an Onset of a Pancreatic Cephalic Carcinoma

Abstract Introduction. The normal anatomy of the cystic duct (CD) has been described a long time ago, but the basic description is valid up today: average length 2-4 mm, caliber 1-1.5 mm, and reduced volume by the spiral mucous folds of Heister. Anatomic variants of the CD and its aberrant insertion lead to confusion during preoperative imaging examinations, and particularly to unpleasant situation during surgery, when the surgeon has to confirm positive identification of the anatomical structures, in order to avoid iatrogenic biliary lesion. The aim of this prospective observation study was to evaluate the eventual bond between the low insertion of the CD in the common hepatic duct (CHD) and the onset of the pancreatic cephalic carcinoma (PCC). Methods. In this study we examined 21 patients with PCC. The inclusion criteria was diagnosed PCC in operable stage. The method for estimation of both, the operability and the site of insertion of the CD into CHD consisted of: ultrasonography (US), endoscopic retrograde cholangiopancreatography (ERCP), CT and MRI. Finally, the surgical procedure was extensive duodenopancreatectomy, Whipple procedure. The surgical procedure was supplemented with periarterectomy and bilateral coeliac ganglienectomy in purpose of radical treatment and denervation. Results. Of the total of 21 patients, we revealed low insertion of the CD (LICD) in 6 patients (28%). In 4 patients (3 male and 1 female), the LICD was presented with complete dilatation of the biliary tree, including CD, CHD and the gallbladder, while in 2 patients the CD and its low insertion were absent on the images-ERCP, CT. In these 2 patients the appearance was amid the cranial infiltration and growth of the carcinoma. Conclusions. Comparison with other reference radiological and anatomical studies, our results significantly differ in the frequency of the appearance of the LICD. This may partially be due to different definitions and criteria referring to LICD. On the other hand, the observed differences may be caused by the eventually present connection between the LICD and PCC. Therefore, further studies with a larger number of participants are necessary (anatomical, pathological and genetic), to confirm or to deny the predicted bond between the LICD and PCC.