Type III: Presence of 2 independent draining ducts, one of which enters the normal position of the papilla of Vater, whereas the second one enters the stomach.
Type IV: Presence of 2 independent draining ducts, one of which enters the normal position of the papilla of Vater, whereas the second one enters the stomach and share one or more intercommunications.
The risk of internal leak is higher after central hepatectomy involving segments IV, V and VIII, possibly due to drainage from aberrant right sided ducts draining into left duct.
A communication between the biloma and the biliary tree is rarely demonstrable; however, cholangiography may show a proximal stricture of the draining intrahepatic duct.
The most important variant of intrahepatic bile duct branching clinically is the presence of an aberrant right posterior sectoral duct draining into the common hepatic duct or cystic duct in 5% of the population.
a Diagram representing a variant segment IV duct draining into the common hepatic duct (CHD) (RASD right anterior sectoral duct, RPSD right posterior sectoral duct, RHD right hepatic duct, LHD left hepatic duct, IV segment four duct).
7, 20– 22 Whereas the right anterior (B5/8) and right posterior (B6/7) sectorial ducts usually drain into the right hepatic duct, this duct may be short or even absent, with both right sectoral ducts draining together with the left hepatic duct directly into the common hepatic duct.
a Diagram representing a variant right anterior sectoral duct (RASD) draining into the left hepatic duct (LHD) (RPSD right posterior sectoral duct, CHD common hepatic duct).
a Diagram representing a variant right posterior sectoral duct (RPSD) draining into the left hepatic duct (LHD) (RASD right anterior sectoral duct, CHD common hepatic duct).
