Division of Gastroenterology, Department of Medicine, University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH 43614, USA.
Gastroenterol Res Pract. 2011;2011:458915. doi: 10.1155/2011/458915. Epub 2011 Apr 7.
Background. Aberrant right hepatic duct (ARHD) draining into cystic duct (CD) is relatively rare but clinically important because of its susceptibility to injuries during cholecystectomy. These injuries are often-times missed or diagnosed late and as a result can develop serious complications. Methods. Four consecutive patients diagnosed with ARHD draining into CD were identified for inclusion. Results. The mean age of patients was 42.5 years. The diagnosis in one of the patient was incidental during a routine endoscopic retrograde cholangiopancreatography (ERCP). Other three patients were diagnosed post-cholecystectomy- one presented with suspected intra-operative biliary injury, one with persistent bile leak and another with recurrent cholangitis. Inadequate filling of the segment of liver on ERCP with dilation of intrahepatic ducts in the corresponding segment on imaging was present in two patients with complete obstruction of ARHD which was managed surgically. In another patient, the partially obstructed ARHD was managed by endoscopic therapy. Conclusion. ARHD draining into the CD can have varied clinical manifestations. In appropriate clinical settings, it should be suspected in patients with persistence of bile leak early after cholecystectomy, segmental dilation of intrahepatic-bile ducts on imaging and paucity of intrahepatic filling in a segment of liver on ERCP.
异常右肝管（ARHD）汇入胆囊管（CD）相对少见，但临床意义重大，因为它在胆囊切除术中容易受伤。这些损伤常常被忽视或诊断较晚，结果可能会发展成严重的并发症。
确定了 4 例连续诊断为 ARHD 汇入 CD 的患者纳入研究。
患者的平均年龄为 42.5 岁。其中 1 例患者在常规内镜逆行胰胆管造影术（ERCP）中偶然发现。另外 3 例患者在胆囊切除术后诊断出，1 例表现为疑似术中胆管损伤，1 例为持续性胆漏，另 1 例为复发性胆管炎。2 例 ARHD 完全梗阻的患者，ERCP 时相应肝段肝内胆管扩张而肝段充盈不足，行手术治疗；另 1 例部分梗阻的 ARHD 患者则行内镜治疗。
ARHD 汇入 CD 可能有不同的临床表现。在适当的临床情况下，对于胆囊切除术后早期持续性胆漏、影像学上肝内胆管节段性扩张和 ERCP 上肝内某一段充盈不足的患者，应怀疑存在 ARHD。
