Cystohepatic triangle
{{Short description|Space between the cystic duct, the common hepatic duct, and the liver}}
{{Infobox anatomy
| Name = Cystohepatic triangle
| Latin = trigonum cystohepaticum
| Image = Gray532.png
| Caption = The cystic artery branches from the right hepatic artery.
| Image2 = Bilebladder.png
| Caption2 = Relationship to other vessels
| Precursor =
| System =
| Artery =
| Vein =
| Nerve =
| Lymph =
}}
The cystohepatic triangle (or hepatobiliary triangle or Calot's triangle) is an anatomic space bordered by the cystic duct laterally, the common hepatic duct medially, and the inferior surface of the liver superiorly.
File:Cystohepatic triangle.png
The cystic artery lies within the hepatobiliary triangle. The triangle is used to locate the cystic artery during a laparoscopic cholecystectomy.
Structure
The hepatobiliary triangle is the area bounded by the:
- cystic duct inferiorly{{Cite journal|last1=Connor|first1=Saxon J.|last2=Perry|first2=William|last3=Nathanson|first3=Leslie|last4=Hugh|first4=Thomas B.|last5=Hugh|first5=Thomas J.|date=May 2014|title=Using a standardized method for laparoscopic cholecystectomy to create a concept operation-specific checklist|url= |journal=HPB|volume=16|issue=5|pages=422–429|doi=10.1111/hpb.12161|issn=1365-182X|pmc=4008160|pmid=23961737}}
- common hepatic duct medially
- inferior margin of the liver superiorlySchwartz's Manual of Surgery BRUNICARDI C.F 10th edition
It is covered in peritoneum both anteriorly and posteriorly.
= Contents =
The triangle contains: adipose and connective tissue, lymphatic vessels and the cystic lymph node, autonomic nerves, (usually) cystic artery, and (sometimes) an accessory cystic duct.{{Cite book |last=Standring |first=Susan |url=https://www.worldcat.org/oclc/1201341621 |title=Gray's Anatomy: The Anatomical Basis of Clinical Practice |year=2020 |isbn=978-0-7020-7707-4 |edition=42th |location=New York |pages=1219 |oclc=1201341621}} The right hepatic artery may also pass through the hepatobiliary triangle.
Clinical significance
{{Unreferenced section|date=January 2010}}
The anatomy and variant anatomy of this region is important during gallbladder removal to prevent iatrogenic injury to the common hepatic duct, bile duct, or right hepatic artery.
The cystic artery lies within the hepatobiliary triangle, which is used to locate it during a laparoscopic cholecystectomy.{{cite journal|last1=Haubrich|first1=William|date=November 2002|title=Calot of the triangle of Calot|journal=Gastroenterology|volume=123|issue=5|pages=1440|doi=10.1053/gast.2002.1231440|pmid=12404217}}{{Cite journal|last1=Orozco|first1=Hector|last2=Mercado|first2=Miguel Angel|last3=Takahashi|first3=Takeshi|last4=Hernández-Ortiz|first4=Jorge|last5=Capellán^S|first5=Juan Félix|last6=Garcia-Tsao|first6=Guadalupe|date=June 1992|title=Elective treatment of bleeding varices with the Sugiura operation over 10 years|url=https://doi.org/10.1016/0002-9610(92)90562-6|journal=The American Journal of Surgery|volume=163|issue=6|pages=585–589|doi=10.1016/0002-9610(92)90562-6|pmid=1595838|issn=0002-9610|url-access=subscription}} It may also contain an accessory right hepatic artery or an anomalous sectoral bile ducts. As a result, dissection in the triangle of Calot is ill-advised until the lateral-most structures have been cleared and identification of the cystic duct is definitive. According to SESAP 12 (produced and distributed by the American College of Surgeons) dissection in the triangle of Calot is the most common cause of common bile duct injuries.
History
Another name used to refer to the hepatobiliary triangle is Calot's triangle, after Jean-François Calot.{{WhoNamedIt|synd|4023}}J. F. Calot. De la cholécystectomie. Doctoral thesis, Paris, 1890. Calot's original description of the triangle in 1890 included the cystic duct, the common hepatic duct, and the cystic artery (not the inferior border of the liver as is commonly believed).
References
{{Torso general}}6. Bailey & Love's Short Practice of Surgery 26th edition (see page 1098).
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