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06-04-2008, 09:16 AM
mEmbryology
The hepatic diverticulum arises from the ventral wall of the foregut and elongates into a stalk to form the choledochus. A lateral bud is given off which is destined to become the gall bladder and cystic duct. The embryonic hepatic duct sends out many branches which join up the canaliculi between the liver cells. During early foetal life the gall bladder is entirely intrahepatic.
m Congenital Abnormalities
1.Absence of the gall bladder:
Occasionally the gall bladder is absent. Failure to visualise the gall bladder is not necessarily a pathological problem.
2. The Phrygian cap
The Phrygian capis present in 2-6 per cent of cholecystograms and may be mistaken for a pathological deformity of the organ. Phrygian cap' refers to hats worn by people of Phrygia, an ancient country of Asia Minor.
3. Floating gall bladder: The organ may hang on a mesentery which makes it liable to undergo torsion.
4-Double gall bladder
Rarely, the gall bladder is twinned. One of the twins may be intrahepatic.
5-Absence of the cystic duct
This is usually a pathological. It indicates the presence of a stone at the lower end of the cystic duct which is ulcerating into the common bile duct. The main danger at surgery is damage to the bile duct, and particular care to identify the correct anatomy is essential before division of any duct.
6- Low insertion of the cystic duct:
The cystic duct opens into the common bile duct near the ampulla. Dissection of cystic duct which is ins0erted low in the bile duct should be avoided as removal will damage the blood supply to the common bile duct and can lead to stricture formation.
7- An accessory cholecystohepatic duct:
Ducts passing directly into the gall bladder from the liver do occur and are probably not uncommon.
8- Extrahepatic biliary atresia.
9- Caroliís disease.
10- Choledochal cyst.
SOURCE: DR. AYMAN SALEM'S BOOK
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