Variations in Cystic Duct Anatomy Using Magnetic Resonance Cholangiopancreatography and their Clinical Significant in the Sudanese

Background: Anatomical variations of the cystic duct are very frequent, and it is substantial to be familiar with these variations preceding to any surgical, percutaneous and endoscopic intervention procedures.Objective: The aim of this study is to determine the normal (typical) and atypical anatomical variations in the cyst duct using magnetic resonance cholangiopancreatography at Fedail Specialized Hospital in Khartoum, Sudan.Materials and Methods: This study is a retrospective evaluation of the cystic duct in 307 patients who were routinely imaged with Magnetic Resonance cholangiopancreatography between November 2019 and March 2021 for various indications.Result: This study included 307 patients aged 6 months to 100 years, of whom 44.3% were male and 55.7% were female. The location, level, and course of the cystic duct were examined. The typical anatomy of the cystic duct was seen in only 30.29% of patients; this percentage is low compared to the range reported in the literature (58–75%). A total of 69.71.% showed atypical configurations. The most common variant was high cystic insertion, observed in 36.2% of cases. Low insertion was observed in 21.8%, low medial insertion in 14.6%, a spiral posterior course in 15.6%, and a parallel course in 10.1%. A short cystic duct less than 5 mm in length was seen in 1% of cases. Other rare findings include a case-for-case (0.3%): absent cystic duct; spiral anterior course with low medial insertion; spiral anterior then posterior; drainage of cystic duct to the right hepatic duct; drainage of the cystic duct at the junction between the right and left hepatic ducts; very high insertion just below the junction of the right and left hepatic ducts; and finally, a case of common bile duct cyst. The relationship between the location, height, and course of the cystic duct and gender was examined, and the result of the chi-square test showed that there was no statistically significant difference between males and females with regard to anatomical variations (p = 0.740). (p=0.671) (p=0.678).Conclusion: The normal anatomy of the cystic duct is observed in only 30.29% of cases. Anatomical variations are encountered in 69.71% of cases, with high insertion of the cystic duct being the main variation observed in 36.2% of cases; the next most common variation is a low insertion in 21.8% of cases.