Abstract:
Background: Anatomical variations of the human body including the extra hepatic biliary
system exist across various individuals. Understanding the variant anatomy of the
extrahepatic biliary system aids surgeons in avoiding iatrogenic injuries. This is important in
resource limited settings where it is not possible to perform adequate radiological
investigations of the hepatobiliary system prior to surgery. This study described the anatomic
variation of the extrahepatic biliary system among Kenyans.
Methods: This was a cross-sectional study conducted at Moi University’s Anatomy
Laboratories among 42 adult cadaveric specimens. Specimen dissections were conducted as
per the fifteenth edition of Cunningham’s manual of Practical Anatomy. The variant anatomy
data collected were filled in a structured data collection form, analysed and presented using
descriptive statistics.
Study Findings: Of the 42 cadavers sampled, 62% (n=26) were male while 38% (n=16) were
female. All had a gall bladder being drained by the cystic duct. The length of the cystic duct
ranged between 7-35 mm joining the common hepatic duct to form the common bile duct in
98% (n=41) of all the cadavers sampled. This confluence was to the left in 7.1% (n=3), right
42.9% (n=18), anteriorly in 14.3% (n=6) and posteriorly 35.7% (n=14). A single cadaver
(2%) had the cystic duct drain into the right hepatic duct. Two thirds (66.7%; n=28) of the
cadavers sampled had the confluence of the right and the left hepatic duct outside the liver.
There were no cholecystohepatic ducts in this study.
Conclusion: The study determined the existence of surgically important variant anatomy of
the extrahepatic biliary system. There is need for greater appreciation of the extrahepatic
biliary system variant anatomy by both surgeons and radiologists so as to decrease morbidity
and improve on surgical outcomes.