Spiral folds of cystic duct

Spiral folds of cystic duct^[2][1] (also known as the spiral mucosal folds,^[3] spiral valves of Cina,^{[citation needed]} Amussat valve, or Cina valves) are a series of crescenteric, spirally arranged mucosal folds^[4][2] in the proximal part of^[2] the cystic duct.^[4][2]

Spiral folds of cystic duct
Details
System	Digestive system
Identifiers
Latin	plicae spirales ductus cystici,[1][2] valvulae spirales[2]
Anatomical terminology [edit on Wikidata]

Anatomy

The folds are 2-10 in number. They project into the lumen of the duct. They are continuous with the folds of the neck of the gallbladder.^[4] They are arranged in a somewhat spiral manner.^[2]

Structure

The spiral valves are supported by underlying smooth muscle fibers.^[3]

Function

The function of the valves is not known.^[4] Since the structures' discovery, various functions have been proposed, including the structural support to the cystic duct, and moderation of the speed of passage of bile through the duct in either direction^[3] Their role has been commonly ascribed to the regulation of bile flow, however,^[4][3] they may instead maintain patency of the duct (i.e. keep the duct open)^[4][5][3] as the duct is thin and tortuous and thus prone to kinking; the observation that the folds are more prominent in younger individuals in whom the duct is also thinner supports this hypothesis.^[3]

Clinical significance

The presence of the spiral folds, in combination with the tortuosity of the cystic duct, makes endoscopic cannulation and catheterization of the cystic duct extremely difficult. The valves of Cina are susceptible to lacerations and were once a serious obstacle to the surgical canalization, which has since been overcome by newer technologies.^[6]

Imaging

On ultrasound, valves of Cina are echogenic.^[7]

References

1. "Anatonomina". www.terminologia-anatomica.org. Retrieved 2023-07-07.
2. "spiral fold of cystic duct". TheFreeDictionary.com. Retrieved 2023-07-07.
3. Dasgupta, D.; Stringer, M. D. (March 2005). "Cystic duct and Heister's "valves"". Clinical Anatomy. 18 (2): 81–87. doi:10.1002/ca.20118. ISSN 0897-3806. PMID 15696536. S2CID 24179512.
4. Standring, Susan (2020). Gray's Anatomy: The Anatomical Basis of Clinical Practice (42th ed.). New York. pp. 1217–1218. ISBN 978-0-7020-7707-4. OCLC 1201341621.{{cite book}}: CS1 maint: location missing publisher (link)
5. "Heister, spiral valve of". TheFreeDictionary.com. Retrieved 2023-07-07.
6. Miller, GL; Laurence, BH; McCarthy, JH (1989). "Cannulation of the cystic duct and gallbladder". Endoscopy. 21 (5): 223–4. doi:10.1055/s-2007-1010730. PMID 2792015. S2CID 260127558.
7. Fitzgerald, E. J.; Toi, A. (1987-07-01). "Pitfalls in the ultrasonographic diagnosis of gallbladder diseases". Postgraduate Medical Journal. 63 (741): 525–532. doi:10.1136/pgmj.63.741.525. ISSN 0032-5473. PMC 2428351. PMID 3309915.

Further reading

• Turner, Mary Ann; Fulcher, Ann S. (2001). "The Cystic Duct: Normal Anatomy and Disease Processes". RadioGraphics. 21 (1): 3–22, questionnaire 288–94. doi:10.1148/radiographics.21.1.g01ja093. PMID 11158640.
• Meilstrup, J W; Hopper, K D; Thieme, G A (1991). "Imaging of gallbladder variants". American Journal of Roentgenology. 157 (6): 1205–8. doi:10.2214/ajr.157.6.1950867. PMID 1950867.