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Cystohepatic triangle
Space between the cystic duct, the common hepatic duct, and the liver

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.

The cystic artery lies within the hepatobiliary triangle. The triangle is used to locate the cystic artery during a laparoscopic cholecystectomy.

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Structure

The hepatobiliary triangle is the area bounded by the:

It is covered in peritoneum both anteriorly and posteriorly.7

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.8 The right hepatic artery may also pass through the hepatobiliary triangle.9

Clinical significance

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.10

The cystic artery lies within the hepatobiliary triangle, which is used to locate it during a laparoscopic cholecystectomy.1112 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.1314 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).15

6. Bailey & Love's Short Practice of Surgery 26th edition (see page 1098).

References

  1. Schwartz's Manual of Surgery BRUNICARDI C.F 10th edition ↩

  2. Connor, Saxon J.; Perry, William; Nathanson, Leslie; Hugh, Thomas B.; Hugh, Thomas J. (May 2014). "Using a standardized method for laparoscopic cholecystectomy to create a concept operation-specific checklist". HPB. 16 (5): 422–429. doi:10.1111/hpb.12161. ISSN 1365-182X. PMC 4008160. PMID 23961737. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008160 ↩

  3. Schwartz's Manual of Surgery BRUNICARDI C.F 10th edition ↩

  4. Connor, Saxon J.; Perry, William; Nathanson, Leslie; Hugh, Thomas B.; Hugh, Thomas J. (May 2014). "Using a standardized method for laparoscopic cholecystectomy to create a concept operation-specific checklist". HPB. 16 (5): 422–429. doi:10.1111/hpb.12161. ISSN 1365-182X. PMC 4008160. PMID 23961737. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008160 ↩

  5. Schwartz's Manual of Surgery BRUNICARDI C.F 10th edition ↩

  6. Connor, Saxon J.; Perry, William; Nathanson, Leslie; Hugh, Thomas B.; Hugh, Thomas J. (May 2014). "Using a standardized method for laparoscopic cholecystectomy to create a concept operation-specific checklist". HPB. 16 (5): 422–429. doi:10.1111/hpb.12161. ISSN 1365-182X. PMC 4008160. PMID 23961737. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008160 ↩

  7. Connor, Saxon J.; Perry, William; Nathanson, Leslie; Hugh, Thomas B.; Hugh, Thomas J. (May 2014). "Using a standardized method for laparoscopic cholecystectomy to create a concept operation-specific checklist". HPB. 16 (5): 422–429. doi:10.1111/hpb.12161. ISSN 1365-182X. PMC 4008160. PMID 23961737. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008160 ↩

  8. Standring, Susan (2020). Gray's Anatomy: The Anatomical Basis of Clinical Practice (42th ed.). New York. p. 1219. ISBN 978-0-7020-7707-4. OCLC 1201341621.{{cite book}}: CS1 maint: location missing publisher (link) 978-0-7020-7707-4 ↩

  9. Connor, Saxon J.; Perry, William; Nathanson, Leslie; Hugh, Thomas B.; Hugh, Thomas J. (May 2014). "Using a standardized method for laparoscopic cholecystectomy to create a concept operation-specific checklist". HPB. 16 (5): 422–429. doi:10.1111/hpb.12161. ISSN 1365-182X. PMC 4008160. PMID 23961737. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008160 ↩

  10. Standring, Susan (2020). Gray's Anatomy: The Anatomical Basis of Clinical Practice (42th ed.). New York. p. 1219. ISBN 978-0-7020-7707-4. OCLC 1201341621.{{cite book}}: CS1 maint: location missing publisher (link) 978-0-7020-7707-4 ↩

  11. Haubrich, William (November 2002). "Calot of the triangle of Calot". Gastroenterology. 123 (5): 1440. doi:10.1053/gast.2002.1231440. PMID 12404217. /wiki/Doi_(identifier) ↩

  12. Orozco, Hector; Mercado, Miguel Angel; Takahashi, Takeshi; Hernández-Ortiz, Jorge; Capellán^S, Juan Félix; Garcia-Tsao, Guadalupe (June 1992). "Elective treatment of bleeding varices with the Sugiura operation over 10 years". The American Journal of Surgery. 163 (6): 585–589. doi:10.1016/0002-9610(92)90562-6. ISSN 0002-9610. PMID 1595838. https://doi.org/10.1016/0002-9610(92)90562-6 ↩

  13. synd/4023 at Whonamedit? http://www.whonamedit.com/synd.cfm/4023.html ↩

  14. J. F. Calot. De la cholécystectomie. Doctoral thesis, Paris, 1890. ↩

  15. Haubrich, William (November 2002). "Calot of the triangle of Calot". Gastroenterology. 123 (5): 1440. doi:10.1053/gast.2002.1231440. PMID 12404217. /wiki/Doi_(identifier) ↩