Anatomical Variations

■ The major anatomical variations are involved with the common bile duct and the right hepatic artery.

■ A very small common bile duct can be mistaken for the cystic duct and completely excised. Even more worrisome is the variant of a low junction of the left and right hepatic ducts (A) or a low junction of the right anterior and right posterior hepatic ducts (B). In these situations the cystic duct can enter the right hepatic duct or the right posterior hepatic duct. The right or right posterior ducts can therefore be mistaken for the cystic duct and divided.

■ More rarely, but even more difficult, particularly in the setting of acute cholecystitis, is when there is no cystic duct and Hartmann's pouch opens directly underneath the right hepatic duct or the common duct.

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