Abstract
The liver is the largest wedge shaped abdominal viscera, situated under the right dome of the diaphragm occupying right hypochondrium and epigastric region. The organ is divided into right and left lobes by the falciform ligament, fissure for ligamentum teres and fissure for ligamentum venosum. A sound knowledge of normal anatomy and morphological variations of liver is important for radiographic imaging and minimally invasive surgical approaches.
The present study was conducted on 32 liver cadaveric specimens collected from routine cadaveric dissection for teaching undergraduate students. The accessory fissures and accessory lobes were observed in 18(56.25%) and 4(12.5%) specimens. The caudate lobe displayed accessory fissures in 12(37.5) % and accessory lobes in 1(3.125%)of the specimens. The quadrate lobe presented the accessory fissures and lobes in 6(18.75%) and 3(9.375%) specimens respectively. Quadrate lobe communicated with the left lobe, as the fissure for ligamentum teres was incomplete in 6(18.75%) specimens. Also, a communication was observed between quadrate lobe and right lobe in 5(15.625%) of the specimens. Fossa for gall bladder was incomplete in 16(50%). One of the specimens displayed a unique presentation with enlarged caudate lobe and a hypertrophied papillary process.
Hepatic surface variations are important for radiologists in making accurate diagnosis during imaging and is a prerequisite for gastroenterologists for better surgical outcome. Henceforth the present study was conducted to observe the morphological variations of the lobes of liver and structures in vicinity.
Keywords: Caudate lobe, Quadrate lobe, Papillary process, Accessory lobe, Pons hepatis, Ligamentum teres.
References
- Standring S, Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 41sted. London: Elsevier 2016.
- Vinnakota S, Jayasree N. A new insight into the morphology of the human liver: a cadaveric study. ISRN 2013; 1(1):1-6.
- Phad VV, Syed SA, Joshi RA. Morphological variations of liver. Int J Health Sci Res 2014; 4:119–124.
- Daver GB, Bakhshi GD, Patil A, Ellur S, Jain M, Daver NG. Bifid liver in a patient with diaphragmatic hernia. Indian J Gastroenterol. 2005; 24(1):27-8.
- Fitzgerald, R.; Hale, M. & Williams, C. R. Case report: accessory lobe of the liver mimicking lesser omental lymphadenopathy. J. Radiol. 1993; 66(789):839-4.
- Feist, J. H. & Lasser, E. C. Identification of uncommon liver lobulations. Am. Med. Assoc. 1959; 169(16):1859-62.
- Wahane A, Satpute C. Normal Morphological Variations of Liver Lobes: A Study on Adult Human Cadaveric Liver in Vidarbha Region. Int. J. Sci. Res. 2015; 4(5): 814-6.
- Sadler TW. Langman’s Medical Embryology. 13th ed. China: Wolters Kluwer 2015.
- Chaudhari HJ, Ravat MK, Vaniya VH, Bhedi AN. Morphological study of human liver and its surgical importance. J Clin Diagn Res 2017;11: AC09-AC12.
- Patil S, Sethi M, Kakar S. Morphological study of human liver and its surgical Importance. Int J Anat Res. 2014, Vol 2(2):310-14.
- Singh HR, Rabi S. Study of morphological variations of liver in human. Res. Anat. 2018; 14 (2019):1–5.
- Chin J, O’Toole P, Lin J, Velavan SS. Hepatic morphology: variations and its clinical importance. Eur. J. Anat. 2018; 22 (3): 195-201.
- Auh YH, Lim JH, Kim KW. et al. Loculated fluid collections in hepatic fissures and recesses: CT appearance and potential pitfalls. Radiographics 1994; 14:529-40.
- Mehta V, Arora J, Manik P, Suri RK, Rath G (2010) Clinico-anatomical aspects of accessory fis-sures obscuring the normal hepatic morphology. Clin Ter 2010; 161(3): 259-260.
- Maharana SS, Sharma A. Accessory liver a rare finding: a cadaveric study. IJPAES 2015; 5: 5140–143.
- Arakawa M, Kimura Y, Sakata K, Kubo Y, Fukushima T, Okuda K. Propensity of ectopic liver to hepatocarcinogenesis: Case reports and Review of the Literature. Hepatology 1999; 29(1):57-61.
- Carrabetta S, Pombo A, Podesta’ R, Auriati L. Torsion and infarction of accessory liver lobe in young man. Surgery 2009; 145:448-49.
- Elmasalme F, Aljudaibi A, Matbouly S, Hejazi N, Zuberi MS. Torsion of an accessory lobe of the liver in an infant. J Pediatr Surg. 1995; 30:1348-50.
- Onitsuka A, Katagiri Y, Miyauchi T, Shimamo-to T, Mimoto H, Ozeki Y Metastatic hepato-ma originating from the pons hepatis presenting extra-hepatic growth- classification of different patterns covering REX’s recessus. Hepatogastroenterology 2003;50(49): 235-237.
- Sugarbaker PH. Pont hepatique (hepatic bridge), an important anatomic structure in cytoreduc-tive surgery. J Surg Oncol 2010; 101(3): 251-252.
- Verrapong J, Solomon H, Helm CW. Divi-sion of the pont hepatique of the liver in cytoreductive surgery for peritoneal malignancy. Gynecol Oncol 2013; 128(1): 133.
Corresponding Author
Dr Tharani Peela
Senior Resident, Department of Anatomy, Vardhman and Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi-110029