In 1863, Luschka reported a thin bile duct passing through the shallow gallbladder fossa to join the right hepatic or common hepatic duct. This duct is now known as the duct of Luschka or a subvesical bile duct. The ducts of Luschka occur in 20–50% of the population
1,2,9. Most commonly, the ducts of Luschka, or subvesical ducts, are encountered in clinical practice as a result of their injury during laparoscopic or open cholecystectomy. Injuries are manifested as a bile leak. Bile leaks occur in 0.2–2% of cases of laparoscopic cholecystectomy
10. Injury to the ducts of Luschka are a relatively frequent cause of such leaks.
The ducts of Luschka, preoperative detection, preoperative imaging of the subvesical dusts of Luschka has have been reported. Kitami et al 11 performed drip-infusion cholangiography with computed tomography (DIC-CT) in 277 patients with cholelithiasis. Subvesical ducts were detected in 28 patients. Intraoperative detection and direct visualization of injured subvesical ducts were reported during the era of open cholecystectomy. We have not been able to find reports of subvesical ducts visualized during initial laparoscopic cholecystectomy in the literature. Postoperative detection in most cases is due to the leaks from injured subvesical ducts, which are diagnosed during the investigation of a postoperative bile leak after laparoscopic cholecystectomy. In general, a patient with symptoms and signs which does not convey a normal postoperative course will undergo investigation with an abdominal ultrasound or CT scan. If a fluid collection is observed, this should be drained under radiologic guidance. If the collection contains bile, an external drainage catheter should be placed. A number of bile leaks will resolve spontaneously 12. The next step is to establish whether there is continuing leakage of bile. This can be accomplished with a variety of modalities, and each one of these can depict a leak from an injured subvesical duct. Fistulography is one of the simplest methods of diagnosing a biliary leak. Retrograde instillation contrast is performed through a surgically or percutaneously placed drain under fluoroscopy. This is performed to demonstrate a communication with the biliary tree. A subvesical duct leak may be detected by this method. Several authors share the opinion that this should be the initial study to be performed in suspected cases 2,13. HIDA scintigraphy is a dynamic study in which an ongoing bile leak may be detected. However, it provides suboptimal anatomic detail. A subvesical duct injury will be shown as extravasation of radionuclide from the gallbladder fossa 14. This is the most common initial study being used to detect a bile leak. Most often, it will lead to further investigation. Endoscopic retrograde cholangiopancreatography (ERCP) is the most commonly used modality in which subvesical duct leaks are diagnosed 3. ERCP also provides a therapeutic solution by reducing intrabiliary pressure with sphincterotomy and endobiliary stent placement. Recently, magnetic resonance (MR) imaging has been introduced into clinical practice for biliary leak detection 15. Reoperation and, specifically, relaparoscopy, can be performed in certain cases of postoperative biliary leaks. Injured subvesical ducts have been visualized during reoperation 16,17. In most cases, ligation of the injured duct and external drainage of bile was considered as sufficient treatment 10,16,17. Reoperation is usually performed when other less invasive modalities fail to either detect or resolve the leak, when they are unavailable, or when symptoms are severe enough to warrant reexploration.
Known as Luschka, bile ducts were described for the first time in 1863 by the German anatomist Hubert von Luschka; draining right liver lobe to right hepatic duct or to the common bile ducts and a number of articles have been reported 18-21. For this reason, we encountered small bile ducts in a single surgeon series, we have identified 8 patients which does not fit the definition of Luschka ducts.
In our study, we notified of bile ducts which are not associated with the injury of large bile ducts. The name of these ducts are subvesical bile ducts, hepatico-cholecystic ducts, or aberrant bile ducts. These ducts are opening to the lumen of the gall bladder and can be involved in bile duct injuries. Treatment modalities for bile duct injuries, may vary and can be different from our described approach.
As a conclusion we may say that subvesical ducts or aberrant bile ducts can be detected during laparoscopic cholecystectomy and the ligation of these ducts may pevent bile leaks.
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