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– Inferior view of the visceral surface of an explanted cadaveric liver. The yellow arrow demonstrates the consistent transverse groove that was present on the visceral surface of segment VI.
Source publication
Introduction:
There have been no previous reports on hepatic surface grooves in an Afro-Caribbean population. This information is important to optimize radiology and hepatobiliary surgical services in the region.
Methods:
Two investigators independently observed 69 cadaveric dissections performed over five years at the University of the West Ind...
Similar publications
Introduction:
There have been no previous reports on the anatomic variations that exist on inferior surface of the liver in Caribbean populations. This information is important to optimize radiology and hepatobiliary surgical services in the region.
Methods:
Two investigators independently observed 69 cadaveric dissections over five years and de...
Citations
... 8 Michael T. Gardner et al, in their study among 69 cadaveric specimens, Six (75%) specimens had 3 or more grooves on the diaphragmaticsurface and most were well-defined deep grooves with a mean length of 4.6 cm and amean depth of 1.8 cmFour cadaveric livers (50%) also had distinctive grooves on the visceral surface.Interestingly, the visceral grooves were all on the right, fewer in number and relativelyconsistent in their location. The distinctive grooves were located on the visceralsurface of segment VI. 9 Total 80 embalmed human livers were evacuated in this study among which 14 livers (17.5%) were normal in their external appearance. However, 66(82.5%) ...
... Hepatic surface grooves (HSGs) are prominent vertical depressions on the antero-superior surface of the liver [5]. Their presence is important to radiologists because they may lead to mis-interpretation of cross-sectional imaging studies [1]. ...
... Their presence is important to radiologists because they may lead to mis-interpretation of cross-sectional imaging studies [1]. They are also important to trauma surgeons as they may mimic liver lacerations, medical oncologists because they can be mistaken for liver metastases in cancer patients and also to hepatobiliary surgeons since they can be used as anatomic landmarks when planning liver resections [1,5,8,14]. ...
... The global prevalence of HSGs ranges from 5% in Malaysia to 40% in Italy [8,14]. One prior study reported a 12% prevalence in the Northern Caribbean [5], but there is no data on the prevalence of HSG in the Eastern Caribbean. This prospective study was designed to document the prevalence of HSGs in an Eastern Caribbean country. ...
PurposeHepatic surface grooves (HSGs) are prominent depressions on the antero-superior surface of the liver. We sought to document the prevalence of HSGs in an Eastern Caribbean population.Methods
We observed all consecutive autopsies performed at a facility in Trinidad and Tobago and recorded the presence, number, location, width, length and depth of any HSG identified. Each liver was then sectioned to document intra-parenchymal abnormalities.ResultsSixty Autopsies were observed. There were HSGs in 9 (15%) cadavers (5 females and 4 males), at an average age of 66 years (range 48–83, Median 64, SD ± 10.4). The HSGs were located on the diaphragmatic surface of the right hemi-liver in 8 (89%) cadavers, left medial section in 4 (44%), left lateral section in 3 (33%) and coursing along Cantlie’s plane in 3 (33%) cadavers. Eight (89%) cadavers with HSGs had other associated anomalies: accessory inferior grooves (5), parenchymal nutmeg changes (5), abnormal caudate morphology (4), hyperplastic left hemi-liver (3), lingular process (2), bi-lobar gallbladder (1) and/or abnormal ligamentous attachments (1).Conclusions
Approximately 15% of unselected Afro-Caribbean persons in this Eastern Caribbean population have HSGs. Every attempt should be made to identify HSGs on pre-operative imaging because they can alert the hepatobiliary surgeon to: (1) associated anatomic anomalies in 89% of cases, (2) associated hepatic congestion in 56% of persons, (3) increased risk of bleeding during liver resections and (4) increased technical complexity of liver resections. The association between HSGs, cardiovascular complications, hepatic congestion and nutmeg liver prompted us to propose a new aetiologic mechanism for HSG formation, involving localized hyperplasia at growth zones due to upregulation of beta-catenin levels.
... El Nakeeb et al. also noted that 10% of remnants occurred in patients with anatomic anomalies [12]. Therefore, it is important to be aware that there is a greater than expected incidence of hepato-biliary anomalies in patients of Caribbean extract [18][19][20][21]. ...
Objective
Removal of a gallbladder remnant occasionally becomes necessary when retained stones become symptomatic. Although the laparoscopic approach has been described, it is not yet considered the standard of care. We sought to determine the outcomes after completion cholecystectomies in the resource-poor setting within the Caribbean.
Methods
We carried out an audit of the databases from all hepatobiliary surgeons in the Anglophone Caribbean. We identified all patients who had completion cholecystectomy over the five-year period from July 1, 2012 to June 30, 2018. Retrospective chart review was performed to extract the following data: patient demographics, diagnoses, presenting complaints, operative details, morbidity, mortality, and clinical outcomes. Descriptive statistics were generated using Statistical Packaging for Social Sciences (SPSS), version 12.0 (SPSS Inc., Chicago IL)
Results
There were 12 patients who were subjected to laparoscopic completion cholecystectomy for acute cholecystitis (7), severe biliary pancreatitis (3), and chronic cholecystitis (2) secondary to stones in a gallbladder remnant. There were 10 women and two men at a mean age of 47.4 years (range 32-60; standard deviation (SD) +/-7.81; median 48; mode 52) and a mean body mass index (BMI) of 30.8 Kg/M² (SD +/-3.81; range 26-38; median 29.5). The mean interval between the index operation and the completion operation was 14.8 months (SD +/- 12.3; range 1-48; median 13; mode 18). Five (42%) patients had their original cholecystectomy using the open approach. Five (42%) index operations were done on an emergent basis and the gallbladder remnant was deliberately left behind in three (25%) index operations. The completion cholecystectomies were all completed laparoscopically in 130.5 minutes (SD +/- 30.5; range 90-180, median 125; mode 125) without any conversions or mortality. There were two minor bile leaks that resolved without intervention through an indwelling drain.
Discussion
Completions cholecystectomy can be completed via the laparoscopic approach with good outcomes and acceptable morbidity and mortality rates. The patients derive the same advantages as elective cholecystectomies. Therefore, the laparoscopic approach, when performed by hepatobiliary surgeons with advanced laparoscopic expertise in specialized centers, should be the new standard of care.
... 8 Michael T. Gardner et al, in their study among 69 cadaveric specimens, Six (75%) specimens had 3 or more grooves on the diaphragmaticsurface and most were well-defined deep grooves with a mean length of 4.6 cm and amean depth of 1.8 cmFour cadaveric livers (50%) also had distinctive grooves on the visceral surface.Interestingly, the visceral grooves were all on the right, fewer in number and relativelyconsistent in their location. The distinctive grooves were located on the visceralsurface of segment VI. 9 Total 80 embalmed human livers were evacuated in this study among which 14 livers (17.5%) were normal in their external appearance. However, 66(82.5%) ...
... These are abnormal, permanent vertical depressions that appear on the surface of the liver. 8 The reported incidence of hepatic surface grooves varies by location from 5% in Maylasia 9 to 25% in the United States 10 and 40% in Italy. 11 In our population, they are seen in 12% of unselected persons. ...
... 11 In our population, they are seen in 12% of unselected persons. 8 The aetiology of hepatic surface grooves remains uncertain, but the prevailing theory proposed by Macchi et al. 11 theorized that there are weak zones on the surface of the liver that offer low resistance to external pressure. Any source of pressure could produce permanent depressions on the liver surface. ...
Chilaiditi’s syndrome describes a symptomatic patient with radiographic findings of interposed colon between the diaphragm and right lobe of liver. It may mimic a pneumoperitoneum on plain radiographs. We present a case in which Chilaiditis’ syndrome was entertained, delaying a decision for laparotomy. This case reinforces the diagnostic difficulty associated with Chilaiditi’s syndrome, and it increases awareness of an uncommon variation in the liver surface anatomy.
... In this age of advanced imaging, it becomes very important for a clinician, surgeon, radiologist and autopsy surgeons to have a thorough knowledge of anatomy and commonly occurring variations in liver. There were variations in the surface anatomy in 12% of randomly selected cadaveric livers [8]. The knowledge of accessory grooves gradually becomes important as cross sectional imaging of abdomen is now an essential part of modern medicine practice specially in the field of hepatobilliary services. ...
Traditional descriptions of liver anatomy refer to a smooth, convex surface contacting the diaphragm. Surface depressions are recognized anatomic variants. There are many theories to explain the cause of the depressions. We discuss the theory that these are caused by hypertrophic muscular bands in the diaphragm.
We report a case of Diaphragmatic ssure on anterior surface of right lobe of liver seen in an adult male cadaver during routine dissection. The ssure is vertically extending in the middle of the anterior surface of right lobe and extends till the inferior border. Length of the ssure is 9 cm and depth is 1.2 cm. Pons hepatis with 13mm length also seen in the same liver. Incidence of Accessory ssures of liver is 25% and frequency increases from 7th decade. 15%of the cadaveric livers may show accessory ssures. The knowledge of the diaphragmatic ssures may be utilized by Anatomists, Surgeons, Forensic specialists and Radiologists to avoid misdiagnosis and complications. When peritoneally disseminated tumor cells implant in such ssures, it may mimic intrahepatic lesions.
Accessory hepatic surface groove is the prominent depression on the antero-superior surface of the liver. A sound knowledge of accessory hepatic surface groove (AHSG) is important to radiologist, trauma surgeon, medical oncologist and hepatobiliary surgeon to be aware of the morphological variations on liver surface. Accessory grooves are more common in right lobe. We present a case report of accessory hepatic surface grooves encountered during laparoscopic cholecystectomy and its clinical signicance.
The hepatic diaphragmatic surface is usually smooth and featureless. Although the existing literature mentions grooves or fissures on the diaphragmatic surface, there is no consensus regarding its causative factors. During routine dissection, the authors found a liver with a broad accessory fissure on the anterior surface of the anatomical right lobe. An enlarged hepatic area was observed on the left side of this accessory fissure. The undersurface of the right hemidiaphragm had a diaphragmatic band that extended into the hepatic fissure. The morphometry of the accessory fissure was studied. Retrospective magnetic resonance imaging showed that the middle hepatic vein was to the immediate right of the accessory fissure. Histological examination was done to confirm the presence of muscle tissue in the hypertrophied diaphragmatic band. As the need for surgeries and transplantations of the liver rises, there is a need to understand the hepatic macroscopic anatomy and its radiological correlation.
