IS COMPRESSION OF THE COMMON BILE DUCT BY THE RIGHT HEPATIC ARTERY A POTENTIAL CAUSE OF INTRAHEPATIC STONES?

Aims:

In 80% of patients the hepatic artery courses between the extrahepatic bile duct and the portal vein. Variations of normal course of the hepatic arteries have already been described as responsible for the onset of jaundice. We present three cases of patients with intrahepatic stones and compression of the common bile duct (CBD) by the right hepatic artery.

Methods:

In this case series 3 patients referred to our center between June 2017 and October 2017 for acute cholangitis. Abdominal ultrasound showed intrahepatic ducts dilation and an alithiasic CBD. MRI showed compression of bile duct just below the main hepatic confluence caused by the right hepatic artery with hilar and intrahepatic stones in all patients. In one patient the CBD was compressed between two branches of the right hepatic artery (Figure 1). ERCP was done in all the patients.

Results:

Cholangiography showed compression of the proximal CBD compatible with the right hepatic artery as suggested by the MRI. Multiple stones just above the compression in all the patients were also detected (figure 2). Biliary sphincterotomy was performed and the stones were extracted with baskets and balloons. After the procedures nasobiliary drains were placed. The day after cholangiography performed via nasobiliary drain showed absence of biliary stones but persisting compression of the CBD below the hilum. In all three patients there were no stones in the distal CBD which showed a normal diameter.

Conclusions:

It is possible that the comprssion of the CBD by the right hepatic artery might be responsible for stones formation just above the compression within dilated intrahepatic ducts.