Accessory bile duct

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

Accessory bile duct
Anatomical terminology

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] Originating from the hepatic parenchyma the accessory bile duct may enter a large bile duct or the gallbladder at any location.[7] Rarely it is found to be connected directly to the GIT.[8] 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 gallbladder 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.[4]

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,[10] 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 or using a drainage guided by radiology.[11]

Eponym

The term is named after German anatomist Hubert von Luschka (1820-1875)[12][13] who described the first case in 1863.[4]

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. (eds.). Mastery of Surgery. Lippincott Williams & Wilkins. pp. 1129–42. ISBN 978-0-7817-7165-8.
  2. 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. 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. S2CID 34673519.
  4. 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. S2CID 8912905.
  5. 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. S2CID 19546499.
  6. "UpToDate". www.uptodate.com.
  7. Balija, M; Huis, M; Szerda, F; Bubnjar, J; Stulhofer, M (2003). "[Laparoscopic cholecystectomy--accessory bile ducts]". Acta Medica Croatica (in Croatian). 57 (2): 105–9. ISSN 1330-0164. PMID 12879689.
  8. Lee, Jei Hee; Yu, Jeong-Sik; Park, Mi-Suk; Yoon, Dong Sup; Yang, Seok Woo (2007). "MR Cholangiography of Accessory Bile Duct Connected to the Stomach". American Journal of Roentgenology. American Roentgen Ray Society. 189 (6): W344–W347. doi:10.2214/ajr.05.1570. ISSN 0361-803X. PMID 18029847.
  9. 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. S2CID 307073.
  10. Balija, M; Huis, M; Szerda, F; Bubnjar, J; Stulhofer, M (2003). "[Laparoscopic cholecystectomy--accessory bile ducts]". Acta Med Croatica. 57 (2): 105–9. PMID 12879689.
  11. Pineño-Flores, Cristina; Segura-Sampedro, Juan José; García-Pérez, José María; Soldevila-García, Carla; Palma-Zamora, Elías; González-Argenté, Francesc Xavier (2017-04-17). "Subvesical duct injury resolved by percutaneous drainage". Gastroenterologia y Hepatologia. 41 (3): 172–174. doi:10.1016/j.gastrohep.2017.03.005. ISSN 0210-5705. PMID 28427730.
  12. 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.
  13. Luschka's ducts at Who Named It?
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