What are the small bile ducts that originate in the gallbladder fossa and drain into ducts located in the right hepatic lobe?

Ducts of Luschka: Anatomical Definition and Clinical Significance

The small bile ducts that originate in the gallbladder fossa and drain in the majority of cases into ducts located in the right hepatic lobe are the Ducts of Luschka (option A).

Anatomical Characteristics

• Ducts of Luschka are developmental abnormalities found within the gallbladder fossa in up to 10% of cholecystectomy specimens 1
• They are classified as non-main biliary ducts (NMBD) in the ATOM classification system, alongside aberrant and accessory ducts 2
• These ducts originate from the right hepatic lobe, course along the gallbladder bed, and usually drain into the extrahepatic bile ducts 3
• Histologically, they typically appear as lobular aggregates of small ductules lined by bland, cuboidal-to-columnar biliary-type epithelium 1

Clinical Significance

• Ducts of Luschka are the second most frequent cause of bile leaks after cholecystectomy, following leaks from the cystic duct stump 3
• They are most often encountered by surgeons when injured during laparoscopic or open cholecystectomy, leading to bile leakage and subsequent peritonitis 1
• The incidence of bile leaks after laparoscopic cholecystectomy ranges from 0.2-2%, with Luschka duct injuries contributing significantly to this rate 3
• Bile leaks from ducts of Luschka are typically low-grade leaks that respond favorably to endoscopic treatment 2

Anatomical Distribution

• In fetal studies, subvesical ducts running along the gallbladder fossa were found in approximately 21.9% of cases 4
• These ducts may drain into various locations:
  • Subsegmental ducts of segment 5 (S5)
  • Right hepatic duct
  • Right anterior branch bile duct
  • Subsegmental ducts of segment 4 (S4) 4

Management of Injuries

• ERCP is the key diagnostic and therapeutic tool for managing bile leaks from ducts of Luschka 2
• The main goal of endoscopic therapy is to reduce the transpapillary pressure gradient to facilitate preferential bile flow through the papilla rather than the leak site 2
• Treatment typically involves:
  • Biliary sphincterotomy with placement of plastic stents
  • Stents are usually left in place for 4-8 weeks 2
• For refractory bile leaks, fully covered self-expanding metal stents have shown superior results compared to multiple plastic stents 2

Prevention of Injuries

• Excessive use of electrocautery to the liver bed during cholecystectomy may injure subcapsular ducts in the gallbladder fossa 5
• Dissection should be kept close to the serosal lining of the gallbladder, preserving the areolar tissue in the gallbladder bed, to avoid injury to ducts of Luschka 5
• Intraoperative cholangiography may help identify some but not all such ducts 3
• Awareness and proper recognition of the anatomic location of these ducts is essential for surgeons performing laparoscopic cholecystectomy 4

Clinical Pitfalls

• Florid proliferation of ducts of Luschka can mimic adenocarcinoma histologically, potentially leading to misdiagnosis 1
• Injuries to these ducts may not be immediately apparent during surgery and can present postoperatively with biliary peritonitis or persistent bile drainage 6
• Untreated lesions of accessory bile ducts, including ducts of Luschka, are a common cause of reoperation following laparoscopic cholecystectomy 6