What are some important normal biliary ductal anatomic variants?
The right posterior segment duct sometimes drains into the left hepatic duct, biliary confluence, or common hepatic duct instead of joining the right anterior segment duct. The cystic duct may parallel the common hepatic duct for some distance and have a low insertion with a consequently long common hepatic duct and a short common bile duct, or it may occasionally insert medially as it joins the common hepatic duct. Accessory ducts can be seen in some patients. Sometimes referred to as ducts of Luschka, they are generally small tributaries of the right hepatic ductal system that drain directly from the liver to enter the gallbladder. These accessory ducts have clinical significance, since they can be a source of bile leak and bile peritonitis following cholecystectomy, which may require treatment with biliary stent placement via ERCP or percutaneous transhepatic biliary drain placement.