SEGMENTAL ANATOMY OF THE INTRAHEPATIC BILE-DUCTS - RELEVANCE TO BILIARY INTERVENTIONS

Understanding the three-dimensional segmental anatomy of the biliary s ystem facilitates interpretation of abnormal findings on cholangiogram s and is of particular importance for safe and successful performance of percutaneous interventions. In our experience, it aids planning of access routes for challenging biliary procedures such as transhepatic removal of intrahepatic bile duct calculi or treatment of segmental bi liary strictures. In addition, consideration of the anatomic relations hip between the intrahepatic biliary system and pleural reflections mi nimizes the risk of inadvertent contamination of the pleural space dur ing transhepatic biliary interventions. We will review the segmental a natomy of intrahepatic bile ducts and will illustrate the value of app lying anatomic knowledge to solve difficult biliary problems.