Left hepatic duct
Tributary · Seg II-IV Seg I (mainly)
Drains segments II, III and IV together with most of the caudate lobe. It has a longer (1.5-2 cm) and more horizontal extrahepatic course beneath segment IV than the right duct, which is why surgeons expose it at the base of the quadrate lobe for hilar bile duct reconstruction (Hepp-Couinaud approach).
Detail
- Drains
- Segments II, III, IV; caudate (I) drains into both ducts, mainly the left
- Extrahepatic length
- 1.5-2 cm; longer and more horizontal than the right duct
When it goes wrong
Primary sclerosing cholangitis in a young man with ulcerative colitis and a raised ALP
Multifocal strictures with intervening dilatation ('beading') of the large intra- and extrahepatic ducts on MRCP; recurrent cholangitis and a lifetime risk of cholangiocarcinoma
Primary biliary cholangitis (middle-aged woman, pruritus, anti-mitochondrial antibodies)
Autoimmune destruction of the small intrahepatic ducts upstream of the hepatic ducts, so the large ducts look normal on imaging despite cholestatic LFTs
Practise this structure
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