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A rare case of arterio-venous malformation in the lower limb
S46
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
Department of Anatomy and Clinical Genetics, Assam Medical College and Hospital, Dibrugarh, Assam, India Objective: Dorsalis pedis artery is the distal extension of anterior tibial artery in the foot. It is the main source of artery to the dorsum of foot. In its normal course it provides the medial tarsal artery, lateral tarsal artery, the first dorsal metatarsal artery, and arcuate artery. The arcuate artery in turn gives rise to second, third, and fourth metatarsal arteries. Hereby, we are presenting a case with variation to this normal pattern. Method: The variation was found during routine dissection of lower limb for academic purpose in the dissection hall of Department of Anatomy and Clinical Genetics, Assam Medical College and Hospital, Dibrugarh, Assam. The course of the arteries was traced, colored, and photographed. All the findings were noted down carefully. Results: The arcuate artery was completely absent and the first metatarsal artery arose from the dorsalis pedis artery. There was one medial tarsal artery and three lateral tarsal arteries: superior, middle, and inferior. The inferior tarsal artery gave rise to the second, third, and fourth dorsal metatarsal arteries. Conclusion: Different studies have shown that variation in branching of dorsalis pedis artery is not uncommon. Hence it is essential to have a sound knowledge of the artery. Prior confirmation of these variations by angiography is of prime importance in surgical operative techniques.
33. A pot pourri of congenital malformations – Meckel Gruber Syndrome – A case report M. Panda, C. Mahapatra, C. Sarangi, R. Biswal, R. Das, A. Mishra, S. Patra, S. Nayak S.C.B.Medical College, Cuttack, Odisha, India Introduction: Congenital anomalies in a fetus, which can be easily diagnosed in the present scenario because of the advanced technologies, are a great disaster to the family members, as well as to the society. The radiological techniques and advancements in genetic studies along with counseling have facilitated the concept of delivering a healthy baby. So also the anatomical studies of these various fetal malformations have posed to be a suitable and confirmative guide to the radiologists and obstetricians. Case Report: Keeping this in view, dead fetuses, which are received in the department of Anatomy from the Obstetricians and Gyenaecology department of S.C.B. Medical College and also from private sectors in the city, are dissected and explored for any kind of anomaly. During such a study, one of the male dead fetus of 21 weeks gestation presented with multiple anomalies. On incising the intact hairy scalp, occipital exencephalocele was seen along with enlarged lateral ventricles. There was presence of lumbosacral meningomyelocele. There was meromelia of both the upper limbs, but with a single digit on the right side, and in the left hand there was a globular mass of tissue instead of the thumb along with well-formed medial four fingers. On exploration of the abdominal cavity and perineum, there was presence of a single enlarged kidney along with hypospadias. Clinical implications of such defects,
the causative factors, and prevention are of paramount importance to the clinicians and surgeons.
34. A rare case of arterio-venous malformation in the lower limb Arun Kumar S. Bilodi ∗ Department of Anatomy, Velammal Medical College Hospital & Research Institute, Anuppanadi, Madurai, Tamil Nadu, India Aim of the study: To report a case of massive enlarged Lower limb and toes due to diffuse Microscopic Arterio-venous Malformation. Place of Study: It was studied in the surgical wards of Government Teaching Hospital, Bangalore. Period of Study: This case was studied in the month of JuneJuly 2014. Case Report: A 27-year-old female presented with history of swelling over the lower limb since birth, associated with skin discolouration of the left thigh. Patient has pain when she walks and stands but it relieved on taking rest. There was also swelling of the left foot with massive enlargement of lateral four toes. She was the only daughter born to nonconsanguineous couple. There was no history of fever or similar complaints in the family. Observations: On examination there was generalized massive swelling of the left lower limb and lateral four toes. There was bluish discolouration of the skin on the lateral aspect. Tenderness was present over the swelling. Discussion: The present study was correlated and well compared with available literature. Conclusion: This is case of Arterio-venous malformation, which has given rise to massive enlargement of left lower limb along with massive enlargement of lateral four toes.
35. A genesis of dorsal pancreas – A case report Arun Kumar S. Bilodi ∗ Department of Anatomy, Velammal Medical College Hospital & Research Institute, Anuppanadi, Madurai, Tamil Nadu, India Aim of the Study: The objective of the present study is to report a case of Agenesis of gall bladder that came across at Velammal Medical College Teaching Hospital. Place of study: This study was done in the Department of Radiology at Velammal Medical College Teaching Hospital. Period of Study: This study was done in the month of July 2014. Case Report: A 51-year-old male presented with abdominal pain to surgical ward with history of abdominal pain since one month. He was examined, investigated and admitted for the abdominal pain. There was history of weight loss. There was also history of ball rolling movement from the right to left. He was alcoholic but stopped alcohol for past 2 months. Conscious and febrile on examination but systemic examination revealed nothing significant. No mass was felt, and also no organomegally. CT Scan showed that Duodenal-jejunal flexure was more towards right. Body and tail of Pancreas
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
Department of Anatomy and Clinical Genetics, Assam Medical College and Hospital, Dibrugarh, Assam, India Objective: Dorsalis pedis artery is the distal extension of anterior tibial artery in the foot. It is the main source of artery to the dorsum of foot. In its normal course it provides the medial tarsal artery, lateral tarsal artery, the first dorsal metatarsal artery, and arcuate artery. The arcuate artery in turn gives rise to second, third, and fourth metatarsal arteries. Hereby, we are presenting a case with variation to this normal pattern. Method: The variation was found during routine dissection of lower limb for academic purpose in the dissection hall of Department of Anatomy and Clinical Genetics, Assam Medical College and Hospital, Dibrugarh, Assam. The course of the arteries was traced, colored, and photographed. All the findings were noted down carefully. Results: The arcuate artery was completely absent and the first metatarsal artery arose from the dorsalis pedis artery. There was one medial tarsal artery and three lateral tarsal arteries: superior, middle, and inferior. The inferior tarsal artery gave rise to the second, third, and fourth dorsal metatarsal arteries. Conclusion: Different studies have shown that variation in branching of dorsalis pedis artery is not uncommon. Hence it is essential to have a sound knowledge of the artery. Prior confirmation of these variations by angiography is of prime importance in surgical operative techniques.
33. A pot pourri of congenital malformations – Meckel Gruber Syndrome – A case report M. Panda, C. Mahapatra, C. Sarangi, R. Biswal, R. Das, A. Mishra, S. Patra, S. Nayak S.C.B.Medical College, Cuttack, Odisha, India Introduction: Congenital anomalies in a fetus, which can be easily diagnosed in the present scenario because of the advanced technologies, are a great disaster to the family members, as well as to the society. The radiological techniques and advancements in genetic studies along with counseling have facilitated the concept of delivering a healthy baby. So also the anatomical studies of these various fetal malformations have posed to be a suitable and confirmative guide to the radiologists and obstetricians. Case Report: Keeping this in view, dead fetuses, which are received in the department of Anatomy from the Obstetricians and Gyenaecology department of S.C.B. Medical College and also from private sectors in the city, are dissected and explored for any kind of anomaly. During such a study, one of the male dead fetus of 21 weeks gestation presented with multiple anomalies. On incising the intact hairy scalp, occipital exencephalocele was seen along with enlarged lateral ventricles. There was presence of lumbosacral meningomyelocele. There was meromelia of both the upper limbs, but with a single digit on the right side, and in the left hand there was a globular mass of tissue instead of the thumb along with well-formed medial four fingers. On exploration of the abdominal cavity and perineum, there was presence of a single enlarged kidney along with hypospadias. Clinical implications of such defects,
the causative factors, and prevention are of paramount importance to the clinicians and surgeons.
34. A rare case of arterio-venous malformation in the lower limb Arun Kumar S. Bilodi ∗ Department of Anatomy, Velammal Medical College Hospital & Research Institute, Anuppanadi, Madurai, Tamil Nadu, India Aim of the study: To report a case of massive enlarged Lower limb and toes due to diffuse Microscopic Arterio-venous Malformation. Place of Study: It was studied in the surgical wards of Government Teaching Hospital, Bangalore. Period of Study: This case was studied in the month of JuneJuly 2014. Case Report: A 27-year-old female presented with history of swelling over the lower limb since birth, associated with skin discolouration of the left thigh. Patient has pain when she walks and stands but it relieved on taking rest. There was also swelling of the left foot with massive enlargement of lateral four toes. She was the only daughter born to nonconsanguineous couple. There was no history of fever or similar complaints in the family. Observations: On examination there was generalized massive swelling of the left lower limb and lateral four toes. There was bluish discolouration of the skin on the lateral aspect. Tenderness was present over the swelling. Discussion: The present study was correlated and well compared with available literature. Conclusion: This is case of Arterio-venous malformation, which has given rise to massive enlargement of left lower limb along with massive enlargement of lateral four toes.
35. A genesis of dorsal pancreas – A case report Arun Kumar S. Bilodi ∗ Department of Anatomy, Velammal Medical College Hospital & Research Institute, Anuppanadi, Madurai, Tamil Nadu, India Aim of the Study: The objective of the present study is to report a case of Agenesis of gall bladder that came across at Velammal Medical College Teaching Hospital. Place of study: This study was done in the Department of Radiology at Velammal Medical College Teaching Hospital. Period of Study: This study was done in the month of July 2014. Case Report: A 51-year-old male presented with abdominal pain to surgical ward with history of abdominal pain since one month. He was examined, investigated and admitted for the abdominal pain. There was history of weight loss. There was also history of ball rolling movement from the right to left. He was alcoholic but stopped alcohol for past 2 months. Conscious and febrile on examination but systemic examination revealed nothing significant. No mass was felt, and also no organomegally. CT Scan showed that Duodenal-jejunal flexure was more towards right. Body and tail of Pancreas