Colecisti (vescica biliare)

La colecisti può essere assente, e in tal caso il dotto epatico è dilatato all’interno del fegato o in qualche tratto del suo decorso. In tre studi l’assenza congenita della colecisti è stata riportata come segue: 1) su 18.350 autopsie l’incidenza dell’assenza era dello 0,065%; 2) su 7.919 autopsie, dello 0,075%; e 3) su 3.661 autopsie, dello 0,03%.

La colecisti e il dotto cistico possono essere assenti.

Talvolta la colecisti è irregolare nella forma o presenta una strozzatura a metà della sua lunghezza; più raramente è parzialmente divisa in senso longitudinale.

Sono stati registrati casi nei quali erano presenti due colecisti distinte, ciascuna con un proprio dotto cistico che si univa al dotto epatico. Lo stesso dotto cistico può essere doppio. Colecisti doppie sono state riscontrate in 5 pazienti su 19.000 (0,026%).

La colecisti è stata rinvenuta sul lato sinistro (a sinistra del legamento rotondo) in soggetti nei quali non vi era una trasposizione generale dei visceri toracici e addominali.

La colecisti può essere intraepatica o situata al di sotto del lobo sinistro. Fra le sedi ectopiche figurano posizioni retroepatiche, oppure la parete addominale anteriore o il legamento falciforme; può essere sovraepatica o disposta trasversalmente, fluttuante o retroperitoneale. Può trovarsi sulla linea mediana, in sede epigastrica anteriore al di sopra del lobo sinistro, o in sede sovraepatica al di sopra del lobo epatico destro.

Le divisioni destra e sinistra del dotto epatico talvolta proseguono separatamente per un certo tratto all’interno del piccolo omento.

Il dotto coledoco può sboccare nel duodeno separatamente dal dotto pancreatico. Possono essere presenti una o due papille duodenali distinte.

Occasionalmente si rinviene tessuto pancreatico anomalo nella parete della colecisti.

Inserzione di dotti biliari aberranti

Dotti extraepatici accessori

Variazioni della colecisti

Duplicazione del dotto coledoco

Colecistectomia laparoscopica, anatomia arteriosa variante

Riferimenti dell’opera originale

Elenco riportato come compare nella fonte, senza normalizzazione dei formati bibliografici. Le voci non sono tradotte: un riferimento bibliografico si cita nella lingua in cui è pubblicato.

• Adam, Y. and W. Metcalf. (1966) Absence of the cystic duct: A case report. The embryology and a review of the literature. Ann. Surg. 164:1056-1058.
• Amussat, M. (1831) Congenital absence of the gallbladder. Am. J. Med. Sci. 8:478.
• Anson, B.J. (1956) Anatomical considerations in surgery of the gallbladder. Q. Bull. Northwestern University Medical School 30:250-259.
• Augustyniak, E., Kocon, K. and S. Zajac. (1968) A rare case of double cystic duct. Folia Morphol. (Warsaw) 27:70-72.
• Bartone, N.F. and R.V. Grieco. (1970) Absent gallbladder and cystic duct. Am. J. Roentgenol. 110:252-255.
• Beck, C. (1899) A case of transposed viscera with cholelithiasis, relieved by a left-sided cholecystostomy. Ann. Surg. 29:593-600.
• Berndt, R. and K. Schmidt. (1972) A case of double gallbladder as an incidential secondary finding in urology. J. Urol. 108:209-210.
• Blanton, D.E., Bream, C.A. and S.R. Mandel. (1974) Gallbladder ectopia: A review of anomalies of position. Am. J. Roentgenol. 121:396-400.
• Blechschmidt, C.M. (1982) Agenesis of the gallbladder - borderline: Case of normality. Anat. Anz. 151:281-285.
• Bonhomme, C. Two cases of the bile duct opening into the pars horizontalis of the duodenum. J. Chir. 119-78.
• Bower, J.O. (1928) Congenital absence of the gall bladder. Ann. Surg. 88:80-90.
• Boyden, E.A. (1927) The accessory gallbladder - an embryological and comparative study of aberrant vesicles occurring in man and the domestic mammals. Am. J. Anat. 38:177-231.
• Boyden, E.A. (1932) The problem of double ductus choledochus: An interpretation of an accessory bile duct found attached to the pars superior of the duodenum. Anatomical Rec. 55:71-93.
• Bret, P.M., de Stempel, J.V., Lough, J.0. and F.F. Illescas. (1988) Intrahepatic, bile duct and portal vein anatomy revisited. Radiology 169:405-407.
• Budde, M. (1924) Verkiimmerung und variation ad den Gallenwegen und ihre praktische Bedeutung. Arch. f. Min. Chir. 128:586-604.
• Campiche, P. (1944) A rare abnormality of the bile ducts: The antiduodenal position of the cystic duct. Ann. Surg. 119:774-776.
• Champetier, J., Davin, J.L., Letoublon, C., Laborde, Y., Yver, R. and F Cousset (1982) Aberrant biliary ducts (vasa aberrantia): Surgical implications. Anat. Clin. 4:137-145.
• Chuang, V.P. (1976) The aberrant gallbladder: Angiographic and radioisotopic observations. Am. J. Roentgenol. (A.J.R.) 12 7:417-421.
• Cole, W.H. (193 1) Congenital malformations of the intestinal tract and bile ducts in infancy and childhood. Arch. Surg. 23:820-847.
• Corcoran, B.B. and K K. Wallace. (1954) Congenital anomalies of the gallbladder. Am. Surg. 20:709-725.
• Couinaud, C. (1953) Mode d'origine de la voie biliaire principàle. Assoc. Anatomistes Comptes Rendus 40:603-610.
• Croudace, W.H.H. (1931) A case of double gall-bladder. Brit. Med. J. 1:107.
• Cruveilhier, -. (1843) Terminaison du canal pancréatique dans le duodenum par un orifice unique et isolé de l'orifice du canal cholédeque. Bulletins et Mem. de la Société Anatomique de Paris XVIII(9):262.
• Cullen, T.S. (1925) Accessory lobes of the liver; an accessory hepatic lobe springing from the surface of the gallbladder. Arch. Surg. 11:718-764.
• Danzis, M. (1935) Congenital absence of the gall bladder. Am. J. Surg. 29:202-207, 308.
• De Font-Réaulx, -. (1864) Absence de vésicule biliaire. Bulletins et Mem. de la Société Anatomique de Paris XXXIX(3):103.
• De font-Réaulx, -. (1865) Anomalie de l'appareil urinaire. -- Quatre uretères complétement indépendents. Bulletins et Mem. de la Societe Anatomique de Paris XL(11):645-646.
• Dixon, C.F. and A.L. Lichtman. (1945) Congenital absence of the gall bladder. Surgery 17:11-21.
• Eisendrath, D.N. (1918) Anomalies of the bile ducts and blood vessels as the cause of accidents in biliary surgery. JAMA 71:864-866.
• Eisendrath, D.N. (1920) The clinical importance of anatomical anomalies in biliary surgery. Boston Med. Surg. J. 182:573-578.
• Everett, C. and H.E. Macumber. (1942) Anomalous distribution of the extrahepatic biliary ducts: Report of a case. Ann. Surg. 115:472-474.
• Feldman, L. and L. Venta. (1988) Percutaneous cholecystomy of an ectopic gallbladder. Gastrointest. Radiol. 13:256-258.
• Ferris, D.O. and I.M. Glaser. (1965) Congenital absence of gallbladder: Four surgical cases. Arch. Surg. 91:359-361.
• Flint, E.R. (1922-23) Abnormalities of the right hepatic, cystic, and gastroduodenal arteries, and of the bile ducts. Brit. J. Surg. 10:509-519.
• Frey, C., Bizer, L. and C. Ernst. (1967) Agenesis of the gallbladder. Am. J. Surg. 114:917-926.
• Friend, E. (1929) Abnormalities of the bile ducts and their blood vessels and their surgical significance. Illinois Med. J. 56:169-180.
• Gerwig, W.H., Countryman, L.K. and A.C. Gomez. (1961) Congenital absence of the gallbladder and the cystic duct. Ann. Surg. 153:113-125.
• Goiney, R.C., Schoenecker, S.A., Cyr, D.R., Shuman, W.P., Peters, M.J. and P.L. Cooperberg. (1985) Sonography of gallbladder duplication and differential considerations. AJR 145:241-243.
• Goodwin, T.W. (1934) Anomalous additional cystic ducts: Report of two cases in which operation was performed. Proc. Staff Meeting Mayo Clin. 9:440-442.
• Goor, D.A. and P.A. Ebert. (1972) Anomaliel of the biliary tree. Report of a repair of an accessory bile duct and review of literature. Arch. Surg. 104:302-309.
• Gray, H.K. and F.B. Whitsell. (1950) Anatomic relationship of the cystic duct to the cystic artery in 100 consective cases of cholecystectomy. Surg. Clin. North Am. 30:1001-1004.
• Gross, R.E. (1936) Congenital anomalies of the gallbladder. A review of 148 cases, with report of double gallbladder. Arch. Surg. 32:131-162.
• Gruber, W. (1875) Ein gabelförmig gespaltener Gallenblasengang - Ductus cysticus bifurcatus. Arch. Pathol. Anat. Physiol. Klin. Med. 63:97.
• Guyton, W.L. (1946) Double gallbladder. Am. J. Surg. 72:118-120.
• Hatfield, P.M. and R.E. Wise (1976) Anatomic variation in the gallbladder and bile ducts. Semin. Roentgenol. 11:157-164.
• Hayes, M.A., Goldenberg, I.S. and C.C. Bishop. (1958) The developmental basis for bile duct anonalies. Surg., Gynecol. Obstet. 107:447-456.
• Hedry, N. von. (1924) Nebenpankreas in der Gallenblasenwand. Beitr. Klin. Chir. 132:570-572.
• Hicken, N.F., Coray, Q.B. and B. Franz. (1949) Anatomic variations of the extrahepatic biliary system as seen by cholangiographic studies. Surg., Gynecol. Obstet. 88:577-584.
• Hochstetter, F. (1886) Anomalien der Pfortader und der Nabelvene in Verbindung mit Defect oder Linkslage der Gallenblase. Arch. Anat. Physiol. Wissen Med. 1886: 369-384.
• Hollinshead, W.H. (1971) Anatomy of Surgeons, 2nd ed., Harper & Row. Pp. 339-340.
• Holzapfel, R. (1930) Die Mündung von Gallen - und Pankreasgang beim Menschen. Anat. Anz. 69:449-453.
• Hopper, K.D. (1988) Hepatic inversion with an epigastric gallbladder. Gastrointestinal Radiol. 13:355- 357.
• Jackson, R.H. (1938) Avoidance of injury to the common bile duct. Surg., Gynecol. Obstet. 67:769-776.
• Job, T.T. (1926) Relationship of common bile and pancreatic ducts. Anat. Rec. 32:212-213.
• Kennon, R. (1933) Double gallbladder opening by two cystic ducts into the common bile duct. Brit. J. Surg. 20:522.
• Korfel, Z. (1966) Two cases of rare variations of the extrahepatic bile ducts observed in vitro. Folia Morphol. (Warsaw) 25:216-218.
• Kreilkamp, B.L. and E.A. Boyden. (1940) Variability in the composition of the sphincter of Oddi. A possible factor in the pathologic physiology of the biliary tract. Anat Rec. 76:485-497.
• Kubik, St. and P. Groscurth. (1977) Ein seltene Anomalie der extrahepatischen Gallenwege und der V. coronaria ventriculi. Chirurg. (Berlin) 48:77-80.
• Kunze, H. (1911) Beiträge zur Anatomie und Chirurgie der Gallenausführungsgänge. Beitr. z. Klin. Chir. 72:491-495.
• Lander, H.H., Lyman, R.Y. and B.J. Anson. (1941) An anatomical consideration of the structure in the hepatic pedicle. Q. Bull. Northwestern University Medical School. 15:103-109.
• Latimer, E.O., Mendez, F.L., Jr. and W.J. Hage. (1947) Congenital absence of gallbladder. Report of a case. Ann. Surg. 126:229-242.
• Leslie, D. (1968) The width of the common bile duct. Surg., Gynecol. Obstet. 126:761-764.
• Lockhart, R.D. (1928) Congenital absence of the gallbladder. J. Anat. Physiol. 57:108-109.
• Lurje, A. (1937) Topography of extrahepatic biliary passages with reference to dangers of surgical technique. Ann. Surg. 105:161-168.
• Mahour, G.H., Wakim, K.G. and D.O. Ferris. (1967) The common bile duct in man: Its diameter and circumference. Ann. Surg. 165:415419.
• Martin, W.B., Ryo, V.Y. and S.M. Pensky. (1984) A focal defect in the dome of the liver caused by an ectopic gallbladder. Noninvasive Med. Imaging 1:115-117.
• Meilstrup, J.W., Hopper, K.D. and G.A. Thieme. (1991) Imaging of gallbladder variants. AJR 157:1205-1208.
• Meyer, J.H., Dowlin, W.M. and S.S. Reinglas. (1949) Double gallbladder. Am. J. Surg. 77:117-119.
• Millbourn, E. (1950) On the excretory ducts of the pancreas in man, with special reference to their relations to each other, to the common bile duct and to the duodenum. Acta Anat. 9:1-34.
• Mincsev, M. (1967) Bilocular gall bladder. Oroskepzes 42:286-298.
• Moosman, D.A. and F.A. Collier. (1951) Prevention of traumatic injury to the bile ducts. A study of the structures of the cystohepatic angle encountered in cholecystectomy and supraduodenal choledochostomy. Am. J. Surg. 82:132-143.
• Mutschmann, P.N. (1946) Aberrant pancreatic tissue in the gallbladder wall. Am. J. Surg. 72:282- 283.
• Neuhof, H. and S. Bloomfield. (1945) The surgical significance of an anomalous Cholicystohepatic duct: Case reports. Ann. Surg. 12 2:2 60265.
• Odimba, B.F.K., Stoppa, R., Henry, X., Largueche, 1. and P. Verhaege. (1982) Two -cases of agenesis of the gallbladder. Remarks on the pathophysiology and diagnosis of this anomaly. J. Chirur. 119:657.
• Ordermatt, W. (1925) Die intrahepatische Variation der Gallenwege, die Ductus hepato-cystici und ihre klinische bedeutung. Beitr. z. Khn. Chir. 133:221-236.
• Osemlak, J. (1972) A combination of congenital anomalies of the bile ducts not described hiterto in man. Folia Morphol. (Warsaw) 31:123-126.
• Pilate, -. (1867) Anomalie de l'uretére, bifidité complète est très rare. Bulletins et Mem. de la Société Anatomique de Paris XLII(6):366-367.
• Priesel, A. (1927) Verdoppelung der Gallenblase beim Menschen. Arch. Pathol. Anat. Physiol. Klin. Med. 265:76-83.
• Purser, J.M. (1886) Case of a liver with two gallbladders. Transactions of the Royal Academy of Medicine in Ireland 5:243-245.
• Rains, A.J.H. (1951-52) Congenital absence of the gall-bladder: Cholangiography: gall stone solvents. Brit J. Surg. 39:37-39.
• Reinhoff, W.F., Jr. and K.L. Pickrell. (1945) Pancreatitis. An anatomic study of the pancreatic and extrahepatic biliary systems. Arch. Surg. 51:205-219.
• Riedel, I. (1888) Ueber den zungenförmigen Fortsatz des rechten leberlappens und seine pathognostiche Bedeutung für die Erkrankung der Gallenblase nebst Bermerkunge über Gallensteinoperationen. Berlin Klin. Wochenschrift 25 (29):577-581, 602-607.
• Ruge, E. (1908) Beiträge zur chirurgischen Anatomie der grossen Gallenwege (Ductus hepaticus, cysticus, choledochus und pancreaticus). Arch. Klin. Chir. 87:47-78.
• Schachner, A. (1916) Anomalies of the gall-bladder and bile passages. With the report of a double gall-bladder and a floating gallbladder. Ann. Surg. 64:419-433.
• Schumacher, O. (1930) über eine Dystropie der Gallenblase bei abnormer Aufteilung der V. portae. Anat. Anz. 69:453-459.
• Singh, I. (1956) Observations on the mode of termination of the bile and pancreatic ducts: Anatomical factors in pancreatitis. J. Anat. Soc. India. 5:54-60.
• Sinner, B.L. (1948) Unusual anomaly of the gallbladder and bile duct. J. Missouri State Med. Assoc. 45:265-266. Cited in Exerpta Medica, Sec. 1, Vol. 3, abstract 665, 1949.
• Slaughter, F.G. and H.H. Trout. (1933) Duplication of the gall bladder. Case report with a review of the literature. Am. J. Surg. 19:124-125, 147.
• Stelmasiak, M. and J. Karski. (1973) Morphology of the orifaces of the common bile duct and pancreatic ducts in man. Folia Morphol. (Warsaw) 32:287-295.
• Stelmasiak, M., Kurylcio, L. and Z. Wójcik. (1970) The anatomic basis of drainage of extrahepatic bile ducts. Folia Morphol. (Warsaw) 29:1-8.
• Sterling, J.A. (1954) The common channel for bile and pancreatic ducts. Surg., Gynecol. Obstet. 98:420-424.
• Stolkind, E. (1939-40) Double gall-bladder. Report of a case and review of 38 cases. Brit. J. Surg. 27:760-766.
• Thorsness, E.T. (1940) An aberrant pancreatic nodule arising on the neck of a human gall bladder from multiple outgrowths of the mucosa. Anat. Rec. 77:319-333.
• Tobias, M.E. (1992) Duplicated gall bladder and situs inversus: Findings on sonography and scintigraphy. AJR 159:1346-1347.
• Tyson, E. (1678) Anatomical observations of an abcess in the liver; a great number of stones in the gall-bag and bilous vessels; a strange conjunction of both kidneys and a great dilation of the vena cava. Phil. Trans. Roy. Soc. London 12:1035-1039.
• Van Gansbeke, D., de Toeuf, J. and M. Cremer. (1984) Suprahepatic gallbladder: A rear congenital anomaly. Gastrointest. Radiol. 9:341-343.
• Villareal, L. (1948) Congenital absence of the gallbladder with case report. Ann. Surg. 127:745-748.
• Weeks, E.A. and C.R. Steinke. (1927) Congenital atresia of bile ducts, biliary cirrhosis and accessory pancreas. Arch. Pediatr. 44:391-394.
• Wood, G.O. and A. Blalock. (1940) Situs inversus totalis and disease of the biliary tract. Arch. Surg. 40:885-896.
• Youngwirth, L.D., Peters, J.C. and M.C. Perry. (1983) The suprahepatic gallbladder. Radiology 149:57- 58.
• Zimmerman, H.G. (1977) Zwischenschaltung der Gallenblase in den Ductus hepatocholedocus, eine seltene anomalies der Gallenwege. Chirurg. 48:73-76.