Common hepatic duct !
The common hepatic duct carries bile out of the liver, formed where the right and left hepatic ducts meet; it is at risk during gallbladder surgery.
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What it is
The duct formed by the right and left hepatic ducts, carrying bile from the liver.
What it does
Joins the cystic duct to form the common bile duct.
Key facts
- Where
- About 3–4 cm, from porta hepatis down the hepatoduodenal ligament; border of hepatocystic (Calot) triangle
- Function
- Carries bile out of the liver
- Drains
- Liver, via union of right and left hepatic ducts
- Into
- Joins cystic duct to form common bile duct
Relations
- Course
- Formed at the porta hepatis by the right and left hepatic ducts, it descends in the hepatoduodenal ligament until the cystic duct joins it
- Behind
- Right hepatic artery, which usually crosses behind it (in front of it in a minority); the portal vein further back
- Medial
- Proper hepatic artery, on its left in the hepatoduodenal ligament
- Lateral
- Cystic duct and gallbladder neck, on its right
How to find it
It cannot be felt. In open surgery it lies in the free edge of the lesser omentum above the cystic duct junction, to the right of the hepatic artery and in front of the portal vein; at cholecystectomy it is the medial side of the hepatocystic triangle, kept in view but not dissected.
On imaging
On ultrasound the duct lies in front of the portal vein at the hilum; when dilated, the two run side by side as parallel tubes (double-barrel or shotgun sign). MRCP maps the confluence and its variants and shows the level of a block before surgery or drainage.
Common problems
- A gallstone stuck in it: jaundice, pain, and sometimes infection (cholangitis) or pancreatitis.
- Injury during cholecystectomy (rare but serious).
How it is diagnosed
Blood tests, ultrasound, MRI (MRCP).
Treatment
- Stones removed by ERCP (an endoscope through the mouth to the duodenum), then usually cholecystectomy.
Clinical notes
- Bile duct injuries are graded (Strasberg, Bismuth) by how close they come to the confluence; high injuries usually need a Roux-en-Y hepaticojejunostomy
- Blocked hilar ducts can be drained from below by ERCP or from above through the liver by percutaneous transhepatic drainage
Anatomical variants
- The right posterior duct may join the left hepatic duct or the common hepatic duct directly; a low aberrant right duct is easily cut during cholecystectomy
- Trifurcation: the right anterior, right posterior and left ducts meet at a single point instead of forming a right hepatic duct first
Development
The extrahepatic ducts come from the stalk of the hepatic diverticulum. In biliary atresia they are progressively destroyed in early infancy, causing jaundice with pale stools; a Kasai portoenterostomy at the hilum is the first operation.
Related conditions
- Choledocholithiasis
- Acute cholangitis
- Primary sclerosing cholangitis
- Cholangiocarcinoma (bile duct cancer)
- Choledochal cyst
- Biliary atresia
Test yourself
Think of the answer, then tap the question to see it.
Which artery usually crosses behind the common hepatic duct?
The right hepatic artery; with the duct on the medial side of Calot triangle, both are at risk in a difficult cholecystectomy.
What is a Klatskin tumour?
A hilar cholangiocarcinoma at the confluence of the right and left hepatic ducts; Bismuth–Corlette grades its spread into them.
What is the double-barrel (shotgun) sign on ultrasound?
A dilated common hepatic duct running parallel in front of the portal vein at the hilum.
Educational information, not medical advice. For any symptom, see a health professional.
Its names
- Official Latin (TA2)
- ductus hepaticus communis TA2 3092
- Official Spanish (DeCS)
- Conducto hepático común DeCS D006500
- English (TA2)
- Common hepatic duct
Related
Sources: Terminologia Anatomica (TA2); DeCS; Anatomy, Abdomen and Pelvis: Biliary Ducts; 23.6 Accessory Organs in Digestion: The Liver, Pancreas, and Gallbladder (OpenStax (Rice University), 2022) · adapted, CC BY 4.0.
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Representative model, for educational purposes only.
