- Email: [email protected]
Inter-arterial anastomosis in human spleen – A case report
j o u r n a l o f t h e a n a t o m i c a l s o c i e t y o f i n d i a 6 4 S ( 2 0 1 5 ) S37–S62
Introduction: Anencephaly, Neural Tube Defect is an embryological malformation of the central nervous system characterized by the absence of the brain, cranial vault and other defects of the cranial structures. Case Presentation: A 35-year-old Indian woman, sixth gravida came to our hospital with labour pain. There was no history of regular antenatal care visit and ultrasound examinations. Full term normal vaginal twin’s delivery had been conducted. First baby was male child of weight 1.8 kg. The second baby was anencephalous, still birth, female child of 1.5 kg having feature of absence of brain and cranial vault. Materials & Methods: The case was obtained from labour room of obstetric department. Embryology: Anencephaly is results from failure of the rostral neuropore to close during the fourth week. As a result, the forebrain primordium is abnormal and development of the calvaria is defective. Evidence suggests that the primary disturbance (e.g., a teratogenic drug) affects cell fates, cell adhesion, and mechanism of neural tube closure. This results in failure of the neural folds to fuse and form the neural tube. Conclusion: Anencephaly can be prevented if women take 400 g of folic acid daily beginning 3 months prior to conception and continuing throughout pregnancy, for this a awareness regarding regular ANC visit and ultrasonography required. Anencephaly is a lethal defect, most of these cases are diagnosed prenatally and the pregnancies terminated.
22. Variations in the branching pattern of abdominal aorta Lattupalli Hema Department Of Anatomy, Narayana Medical College, Chinthareddypalem, Nellore, AP, India Introduction: Abdominal Aorta and its variations have attracted the attention of anatomists, surgeons and radiologists since decades. Coeliac trunk is the most welldocumented arterial trunk that made many researchers ponder about it. Objective: The aim of this study was to identify the origin and distribution of Inferior Phrenic Artery in normal and pathological cases, and to apply such findings to clinical scenario of Hepatocellular Carcinoma. Method: During a routine educational dissection of a 45 years aged male cadaver, a variation in the branching pattern of abdominal aorta was observed. A careful resection of the interrupting tissues was done and the variations were noted. Results: The trifurcation of the coeliac trunk called as “Tripus Halleri” by Haller (1765) was observed along with an additional branch the “Left Inferior Phrenic Artery”. Towards the right side the Middle Suprarenal artery and the Inferior Phrenic Artery originated from the abdominal aorta as common trunk. Conclusion: The above aberrant arterial combination carries clinical significance for surgeons dealing with a variety of interventions (e.g., gastric and duodenal ulcers, mobilization of the head of the pancreas), in terms of minimizing blood loss. Surgeons operating on the upper abdomen, such as during liver transplantation and the biliary tract, must be aware
S43
of such anatomical variants, as any erroneous artery ligation could lead to liver lobe or segmental necrosis.
23. Unusual formation and distribution of the superficial palmar arch – A case report D. Shetty Surekha, B. Nayak Satheesha, S.N. Somayaji, K.G. Rao Mohandas Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal University, Manipal, Karnataka State, India Introduction: Variations in the formation and distribution of the superficial palmar arch (SPA) are common. Case Report: We found a rare variation in the formation and distribution of the same on the left upper limb of an approximately 60-year-old male cadaver. The SPA is normally formed by the direct continuation of the ulnar artery (UA) and completed by the superficial palmar branch of the radial artery (RA). It gives one proper digital and three common digital branches in the palm. In the current case, the superficial palmar arch was formed by the UA and it was incomplete laterally as there was no contribution from the RA. It gave a proper digital branch to the medial side of the digitus minimus, and four common digital branches. The lateralmost among the common digital branches divided into princeps pollicis and radialis indicis arteries. The deep branch of the UA arose from the proper digital branch going to the digitus minimus. Knowledge of variations of vascular patterns of hand has gained more importance in microsurgical techniques, like reconstructive hand surgeries. Preoperative screening was done of RA harvesting for myocardial revascularization and also in arterial interventions that include RA cannulation and RA forearm flap. The current report is of special interest to the hand surgeons and radiologists.
24. Inter-arterial anastomosis in human spleen – A case report Ahmed Abdul Alim, Deka Rup Sekhar, Talukdar Kunjala Gauhati Medical College, Guwahati, Assam, India Objective: A case report on an inter-arterial anastomosis in human cadaveric spleen. Materials and Methods: During a routine dissection of abdomen of approximately 42-year-old male cadaver allotted to first year MBBS students in the Dept. of Anatomy, Gauhati Medical College, Guwahati, a spleen with an inter-arterial anastomosis between terminal branches of splenic artery was found. Result and Observation: Normally the spleen is supplied by segmental branches and polar arteries. The parts of the spleen, which were supplied by these segmental branches, were separated by an avascular zone. In the present case, an inter-arterial anastomosis was found between the arteries of the adjacent segments. Conclusion: The findings of this study are useful for surgeons especially in partial splenectomy. This will also give
S44
j o u r n a l o f t h e a n a t o m i c a l s o c i e t y o f i n d i a 6 4 S ( 2 0 1 5 ) S37–S62
reliable information to the anatomists for learning and also for teaching of splenic anatomy. The details of the study will be discussed at the time of presentation.
25. Origin of pronator teres muscle by three heads: A case report
of the body of pancreas and reached up to left colic flexure, where it divided into ascending branch anastomosing with left branch of middle colic, and descending branch anastomosing with ascending branch of left colic artery proper. Knowledge of this anomalous origin and unusual course of the rare accessory left colic artery is surgically relevant, as it is liable to get injured during pancreatic surgeries and is essential in interpretation of radiological and vascular interventional studies.
T. Ahmad 1 , R.Q. Khan 2 1 Department of Anatomy, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India; 2 Department of Anatomy, MAMC, New Delhi, India
27. Cholecystohepatic duct: A case report
Introduction: The pronator teres is generally originated by the two heads, namely humeral and ulnar. The humeral head is the larger of the two, and begins above the medial epicondyle on the medial supracondylar ridge and the common flexor tendon. The ulnar head originates below the elbow on the medial side of the coronoid process of the ulna. The anatomical variations already have been noted and include the absence of ulnar head, additional slips from the medial intermuscular septum, from the Biceps, from the Brachialis and occasional hypertrophy of the muscle mass. Case Report: During routine anatomical dissection of the left upper extremity of an adult male cadaver, the pronator teres muscle was found to have an abnormal third head. This third head took its origin from fascia covering the flexor carpi radialis muscle. The three heads come together, cross the forearm diagonally and insert halfway down the lateral surface of the radius via a tendon. Such variations have clinical implications and therefore while managing patients with neurogenic pain in the wrist or a median nerve paralysis with symptoms of lower brachial artery or brachial vein compression, such anatomical variations should always be kept in mind.
Gauhati Medical College, Guwahati, Assam
Medhi Shobhana, K.L. Talukdar
Introduction: The human biliary tree is reported to present with a wide range of anatomical variations, so much so that a normal anatomic pattern is described to be non-existent. One of the reported variations of the biliary tree is the presence of some aberrant bile ducts called the Cholecystohepatic Ducts, which are described to be some persistent fetal connections between the liver and either the gallbladder or the extrahepatic bile ducts. True cholecystohepatic connections are rare. Though rare, knowledge of these variants is of utmost importance as failure to recognise them during surgeries, may be responsible for considerable morbidity following what should have been an uneventful surgical procedure. Case Report: We report such a rare case that was encountered during routine dissection of an adult female cadaver. In this case, a small, slender aberrant bile duct was found in the gallbladder fossa, connecting the right hepatic lobe with the gallbladder. The gallbladder was seen to be drained by a cystic duct that ultimately joined the common hepatic duct to form the common bile duct, which in turn drained into the second part of the duodenum. The rest of the extrahepatic biliary tree was found to be as per standard textbook descriptions.
26. Accessory left colic artery from middle colic artery and its surgical significance – A case report
28. Common bile duct duplication: A case report
S.B. Rangrej, S. Kakar, A. Mahajan
Medhi Shobhana, K.L. Talukdar
Maulana Azad Medical College, New Delhi, India
Gauhati Medical College, Guwahati, Assam, India
Introduction: Left colic artery normally arises as first branch of inferior mesenteric artery from its left side and supplies most of left colic flexure and descending colon. It run laterally and upwards, towards left colic flexure, where it divides into ascending and descending branches. The region of left colic flexure supplied by left colic artery along with adjoining transverse colon and descending colon can very rarely have an adjunct supply by an infrequent accessory left colic artery. Variable origin of accessory left colic artery has been reported earlier, but there is very minimal literature in Indian population. Case Report: During routine cadaveric dissection in a 40-yearold male cadaver, an anomalous accessory left colic artery was found. This artery was originating from middle colic artery before its division into right and left branches. It had an unusual course towards left side along the inferior border
Introduction: Common Bile Duct Duplication or Double Common Bile Duct (DCBD) is a rare congenital anomaly of the extra-hepatic biliary apparatus, characterised by the presence of two common bile ducts draining bile from different parts of the liver. One of them is seen to normally drain into the Major Duodenal Papilla and the other, which is named the Accessory Common Bile Duct (ACBD), drains into different parts of the upper gastro-intestinal tract (stomach, duodenum, ductus pancreaticus or septum). Awareness of is anomaly is of utmost importance as it is often reported to lead to complications such as choledocholithiasis, cholangitis, pancreatitis and upper gastro-intestinal malignancies. Besides, this condition is reported to be associated with Anomalous Pancreatico-Biliary Junction (APBJ) and choledochal cyst. Case Report: We present here, a unique variant of Double Common Bile Duct with anomalous union of the
Introduction: Anencephaly, Neural Tube Defect is an embryological malformation of the central nervous system characterized by the absence of the brain, cranial vault and other defects of the cranial structures. Case Presentation: A 35-year-old Indian woman, sixth gravida came to our hospital with labour pain. There was no history of regular antenatal care visit and ultrasound examinations. Full term normal vaginal twin’s delivery had been conducted. First baby was male child of weight 1.8 kg. The second baby was anencephalous, still birth, female child of 1.5 kg having feature of absence of brain and cranial vault. Materials & Methods: The case was obtained from labour room of obstetric department. Embryology: Anencephaly is results from failure of the rostral neuropore to close during the fourth week. As a result, the forebrain primordium is abnormal and development of the calvaria is defective. Evidence suggests that the primary disturbance (e.g., a teratogenic drug) affects cell fates, cell adhesion, and mechanism of neural tube closure. This results in failure of the neural folds to fuse and form the neural tube. Conclusion: Anencephaly can be prevented if women take 400 g of folic acid daily beginning 3 months prior to conception and continuing throughout pregnancy, for this a awareness regarding regular ANC visit and ultrasonography required. Anencephaly is a lethal defect, most of these cases are diagnosed prenatally and the pregnancies terminated.
22. Variations in the branching pattern of abdominal aorta Lattupalli Hema Department Of Anatomy, Narayana Medical College, Chinthareddypalem, Nellore, AP, India Introduction: Abdominal Aorta and its variations have attracted the attention of anatomists, surgeons and radiologists since decades. Coeliac trunk is the most welldocumented arterial trunk that made many researchers ponder about it. Objective: The aim of this study was to identify the origin and distribution of Inferior Phrenic Artery in normal and pathological cases, and to apply such findings to clinical scenario of Hepatocellular Carcinoma. Method: During a routine educational dissection of a 45 years aged male cadaver, a variation in the branching pattern of abdominal aorta was observed. A careful resection of the interrupting tissues was done and the variations were noted. Results: The trifurcation of the coeliac trunk called as “Tripus Halleri” by Haller (1765) was observed along with an additional branch the “Left Inferior Phrenic Artery”. Towards the right side the Middle Suprarenal artery and the Inferior Phrenic Artery originated from the abdominal aorta as common trunk. Conclusion: The above aberrant arterial combination carries clinical significance for surgeons dealing with a variety of interventions (e.g., gastric and duodenal ulcers, mobilization of the head of the pancreas), in terms of minimizing blood loss. Surgeons operating on the upper abdomen, such as during liver transplantation and the biliary tract, must be aware
S43
of such anatomical variants, as any erroneous artery ligation could lead to liver lobe or segmental necrosis.
23. Unusual formation and distribution of the superficial palmar arch – A case report D. Shetty Surekha, B. Nayak Satheesha, S.N. Somayaji, K.G. Rao Mohandas Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal University, Manipal, Karnataka State, India Introduction: Variations in the formation and distribution of the superficial palmar arch (SPA) are common. Case Report: We found a rare variation in the formation and distribution of the same on the left upper limb of an approximately 60-year-old male cadaver. The SPA is normally formed by the direct continuation of the ulnar artery (UA) and completed by the superficial palmar branch of the radial artery (RA). It gives one proper digital and three common digital branches in the palm. In the current case, the superficial palmar arch was formed by the UA and it was incomplete laterally as there was no contribution from the RA. It gave a proper digital branch to the medial side of the digitus minimus, and four common digital branches. The lateralmost among the common digital branches divided into princeps pollicis and radialis indicis arteries. The deep branch of the UA arose from the proper digital branch going to the digitus minimus. Knowledge of variations of vascular patterns of hand has gained more importance in microsurgical techniques, like reconstructive hand surgeries. Preoperative screening was done of RA harvesting for myocardial revascularization and also in arterial interventions that include RA cannulation and RA forearm flap. The current report is of special interest to the hand surgeons and radiologists.
24. Inter-arterial anastomosis in human spleen – A case report Ahmed Abdul Alim, Deka Rup Sekhar, Talukdar Kunjala Gauhati Medical College, Guwahati, Assam, India Objective: A case report on an inter-arterial anastomosis in human cadaveric spleen. Materials and Methods: During a routine dissection of abdomen of approximately 42-year-old male cadaver allotted to first year MBBS students in the Dept. of Anatomy, Gauhati Medical College, Guwahati, a spleen with an inter-arterial anastomosis between terminal branches of splenic artery was found. Result and Observation: Normally the spleen is supplied by segmental branches and polar arteries. The parts of the spleen, which were supplied by these segmental branches, were separated by an avascular zone. In the present case, an inter-arterial anastomosis was found between the arteries of the adjacent segments. Conclusion: The findings of this study are useful for surgeons especially in partial splenectomy. This will also give
S44
j o u r n a l o f t h e a n a t o m i c a l s o c i e t y o f i n d i a 6 4 S ( 2 0 1 5 ) S37–S62
reliable information to the anatomists for learning and also for teaching of splenic anatomy. The details of the study will be discussed at the time of presentation.
25. Origin of pronator teres muscle by three heads: A case report
of the body of pancreas and reached up to left colic flexure, where it divided into ascending branch anastomosing with left branch of middle colic, and descending branch anastomosing with ascending branch of left colic artery proper. Knowledge of this anomalous origin and unusual course of the rare accessory left colic artery is surgically relevant, as it is liable to get injured during pancreatic surgeries and is essential in interpretation of radiological and vascular interventional studies.
T. Ahmad 1 , R.Q. Khan 2 1 Department of Anatomy, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India; 2 Department of Anatomy, MAMC, New Delhi, India
27. Cholecystohepatic duct: A case report
Introduction: The pronator teres is generally originated by the two heads, namely humeral and ulnar. The humeral head is the larger of the two, and begins above the medial epicondyle on the medial supracondylar ridge and the common flexor tendon. The ulnar head originates below the elbow on the medial side of the coronoid process of the ulna. The anatomical variations already have been noted and include the absence of ulnar head, additional slips from the medial intermuscular septum, from the Biceps, from the Brachialis and occasional hypertrophy of the muscle mass. Case Report: During routine anatomical dissection of the left upper extremity of an adult male cadaver, the pronator teres muscle was found to have an abnormal third head. This third head took its origin from fascia covering the flexor carpi radialis muscle. The three heads come together, cross the forearm diagonally and insert halfway down the lateral surface of the radius via a tendon. Such variations have clinical implications and therefore while managing patients with neurogenic pain in the wrist or a median nerve paralysis with symptoms of lower brachial artery or brachial vein compression, such anatomical variations should always be kept in mind.
Gauhati Medical College, Guwahati, Assam
Medhi Shobhana, K.L. Talukdar
Introduction: The human biliary tree is reported to present with a wide range of anatomical variations, so much so that a normal anatomic pattern is described to be non-existent. One of the reported variations of the biliary tree is the presence of some aberrant bile ducts called the Cholecystohepatic Ducts, which are described to be some persistent fetal connections between the liver and either the gallbladder or the extrahepatic bile ducts. True cholecystohepatic connections are rare. Though rare, knowledge of these variants is of utmost importance as failure to recognise them during surgeries, may be responsible for considerable morbidity following what should have been an uneventful surgical procedure. Case Report: We report such a rare case that was encountered during routine dissection of an adult female cadaver. In this case, a small, slender aberrant bile duct was found in the gallbladder fossa, connecting the right hepatic lobe with the gallbladder. The gallbladder was seen to be drained by a cystic duct that ultimately joined the common hepatic duct to form the common bile duct, which in turn drained into the second part of the duodenum. The rest of the extrahepatic biliary tree was found to be as per standard textbook descriptions.
26. Accessory left colic artery from middle colic artery and its surgical significance – A case report
28. Common bile duct duplication: A case report
S.B. Rangrej, S. Kakar, A. Mahajan
Medhi Shobhana, K.L. Talukdar
Maulana Azad Medical College, New Delhi, India
Gauhati Medical College, Guwahati, Assam, India
Introduction: Left colic artery normally arises as first branch of inferior mesenteric artery from its left side and supplies most of left colic flexure and descending colon. It run laterally and upwards, towards left colic flexure, where it divides into ascending and descending branches. The region of left colic flexure supplied by left colic artery along with adjoining transverse colon and descending colon can very rarely have an adjunct supply by an infrequent accessory left colic artery. Variable origin of accessory left colic artery has been reported earlier, but there is very minimal literature in Indian population. Case Report: During routine cadaveric dissection in a 40-yearold male cadaver, an anomalous accessory left colic artery was found. This artery was originating from middle colic artery before its division into right and left branches. It had an unusual course towards left side along the inferior border
Introduction: Common Bile Duct Duplication or Double Common Bile Duct (DCBD) is a rare congenital anomaly of the extra-hepatic biliary apparatus, characterised by the presence of two common bile ducts draining bile from different parts of the liver. One of them is seen to normally drain into the Major Duodenal Papilla and the other, which is named the Accessory Common Bile Duct (ACBD), drains into different parts of the upper gastro-intestinal tract (stomach, duodenum, ductus pancreaticus or septum). Awareness of is anomaly is of utmost importance as it is often reported to lead to complications such as choledocholithiasis, cholangitis, pancreatitis and upper gastro-intestinal malignancies. Besides, this condition is reported to be associated with Anomalous Pancreatico-Biliary Junction (APBJ) and choledochal cyst. Case Report: We present here, a unique variant of Double Common Bile Duct with anomalous union of the