How is the common hepatic duct formed?
The duct belongs to the extrahepatic biliary system. The right and left hepatic ducts (ductus hepatici dexter et sinister) converge to form the common hepatic duct (ductus hepaticus communis).
The right and left hepatic ducts and their segmental branches are not constant anatomical structures: when they are absent, the respective ducts drain directly into the common hepatic duct.
Location and borders
The common hepatic duct emerges from the liver in the region of the porta hepatis (porta hepatis), which is part of the fissure system including the fissures for the inferior vena cava, ligamentum teres, and ligamentum venosum.
Leaving the porta hepatis, the duct runs within the hepatoduodenal ligament (lig. hepatoduodenale). The porta hepatis contains:
- proper hepatic artery (a. hepatica propria) and its left and right branches;
- portal vein (v. portae);
- nerves and lymphatic vessels.
Wall structure and dimensions
The average dimensions of the common hepatic duct are 4–5 cm in length and 4–5 mm in diameter.
Structural features:
- the mucosa is smooth and devoid of folds;
- the submucosa of the walls of the extrahepatic bile ducts contains mucous glands (glandulae mucosae ductulorum biliarium).
Confluence with the cystic duct
At a distance of 2.5–3.0 cm inferior to the junction of the lobar ducts, the cystic duct (ductus cysticus) empties into the common hepatic duct. The cystic duct is about 3 cm long and 3–4 mm in diameter, arises from the neck of the gallbladder, forms two bends, and courses superiorly and to the right.
Variants of cystic duct insertion into the common hepatic duct:
- at an acute or obtuse angle;
- parallel to the common hepatic duct for some distance;
- spiraling around the hepatic duct.
The union of these two ducts forms the common bile duct (ductus choledochus), which is the direct continuation of the common hepatic duct. It also lies within the hepatoduodenal ligament, has a length of 5–8 cm (sometimes up to 12 cm), and possesses a muscular layer with the sphincter of the common bile duct. The common bile duct opens at the apex of the major duodenal papilla.
Clinical significance
In intrahepatic cholangiocarcinoma or cancer of the proximal extrahepatic bile ducts, if the planned volume of the remaining liver parenchyma is less than 40%, selective endovascular embolization of the portal vein branches—typically the right branch, and occasionally branches of segment IV—is performed.
The dynamics of volume increase are evaluated no earlier than 3–5 weeks post-embolization. Embolization aims to induce vicar (compensatory) hypertrophy of the remaining lobe and reduce the risk of post-resection liver failure. Surgical treatment is performed once the remaining parenchymal volume reaches ≥ 40%.
Class and exam questions
Which ducts form the common hepatic duct?
It is formed by the convergence of the right and left hepatic ducts (ductus hepatici dexter et sinister) at the porta hepatis.
In which ligament does the ductus hepaticus communis run?
The duct lies within the substance of the hepatoduodenal ligament (lig. hepatoduodenale), in close proximity to the portal vein and proper hepatic artery.
Are there folds in the mucosa of the common hepatic duct?
No, the mucosa of this duct is smooth and lacks folds, unlike the cystic duct, which features a spiral fold.
What is formed by the union of the common hepatic and cystic ducts?
Their union forms the common bile duct (ductus choledochus), which is the direct continuation of the common hepatic duct.
What else to study on this topic
- Common bile duct (ductus choledochus)
- Cystic duct (ductus cysticus)
- Hepatoduodenal ligament (lig. hepatoduodenale)
- Porta hepatis (porta hepatis)
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