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© 2019 |Published by Scholars Middle East Publishers, Dubai, United Arab Emirates 128
Scholars International Journal of Anatomy and Physiology
Abbreviated Key Title: Sch Int J Anat Physiol
ISSN 2616-8618 (Print) |ISSN 2617-345X (Online)
Scholars Middle East Publishers, Dubai, United Arab Emirates
Journal homepage: http://saudijournals.com/sijap/
Original Research Article
A Morphological Study of Caudate Lobe in Human Cadaveric Liver
Dr. Jaikumar B. Contractor, M.D1, Dr. Bhavin B. Kodiyatar, M.D2, Dr. V. H. Vaniya, M.S3
1Assistant Professor, Department of Anatomy, Pramukhswami Medical College, Karamsad, Gujarat, India
2Assistant Professor, Department of Anatomy, B. J. Medical College, Ahmedabad, Gujarat, India
3Professor, Department of Anatomy, Baroda Medical College, Vadodara, Gujarat, India
*Corresponding author: Dr. Bhavin B. Kodiyatar | Received: 02.03.2019 | Accepted: 05.03.2019 | Published: 30.03.2019
DOI:10.21276/sijap.2019.2.3.9
Abstract
The liver is the largest abdominal visceral organ, occupying a substantial portion of the upper abdominal cavity. The liver
has four lobes, Caudate lobe is a separate and distinct liver lobe. It is located on liver at the posterior surface. The caudate
lobe has two portions joined by a narrow parenchymal bridge that is called the caudate isthmus. Caudate lobe also has its
separate blood supply and biliary drainage. The complexity of liver function and its importance in body homeostasis has
encouraged this study of morphology and variations of caudate lobe to better the diagnosis and analysis of clinico-
pathological conditions. For present study 100 cadaveric livers were obtained. Caudate lobe was studied on various
parameters such as shape, size and dimensions. Various measurements were taken and data was analyzed using
descriptive statistics and relational statistics. ‘Z’ test was computed to find out the association between the parameters of
the present study and the studies of similar background. It was found that majority of the caudate lobes in all livers are
rectangular 67 (67%) in shape followed by pyriform 21 (21%) and irregular 12 (12%) shaped. The average transverse
diameter of caudate was measured 28.69 ± 7.73.The average longitudinal diameter of caudate lobe was measured 54.67 ±
10.73. A sound knowledge of the normal and variant liver anatomy is a prerequisite to having a favorable surgical
outcome and commonly occurring variations assumes even more significance in the era of diagnostic imaging and
minimally invasive surgical approaches.
Keywords: Liver, Caudate Lobe, Surgical resection, Harbin’s measurements.
Copyright @ 2019: This is an open-access article distributed under the terms of the Creative Commons Attribution license which permits unrestricted
use, distribution, and reproduction in any medium for non-commercial use (NonCommercial, or CC-BY-NC) provided the original author and source
are credited.
INTRODUCTION
The liver is one of the largest abdominal
organs, occupying a large portion of the upper
abdominal cavity. It is present in right hypochondria
and epigastrium, and extending into left hypochondria
as far as left lateral line [1]. The liver has four lobes;
gross anatomical appearance of the liver has been
divided into the right, left, caudate and quadrate lobes
by the surface peritoneal and ligamentous attachments
[2]. Various ducts, veins and arteries are present on the
surface of the lobes that allow the inflow and outflow of
fluids [3]. Caudate lobe is a separate and distinct liver
lobe. It is located on the posterior surface of the liver
between the groove for inferior vena cava (IVC) to the
right and fissure for Ligamentum venosum to the left
and on the anterior side of porta hepatis. The caudate
lobe has two portions joined by a narrow parenchymal
bridge called the caudate isthmus. This lobe also has
separate blood supply and biliary drainage [4].
In man, the liver is essential for survival since
there is currently no artificial organ or equipment that
has the capacity to compensate for the absence of liver
function [5]. The complexity of liver function and its
importance in body homeostasis has encouraged many
anatomists to study the morphological features of the
organ in considerable detail [6]. For the surgeons it is of
paramount importance to have clear knowledge of the
structure of the normal organ and its variations during
the period of growth and ageing.
MATERIAL & METHODS
The study was conducted on 100 cadaveric
livers obtained from the Department of Anatomy,
Baroda Medical College, Gujarat, India. Any liver from
cadavers with previous history or appearance of
cirrhosis, metastatic disease or other liver pathology
and any cadavers with previous history of or an
appearance suggestive of any trauma disease or
abdominal surgery were excluded from the study. The
approval was obtained from the Institutional Ethics
Committee for Human research, Medical College
Baroda, Gujarat prior to the commencement of the
study. The liver specimens collected were allotted
numbers from 1 to 100. The numbering to the
specimens were given using synthetic thread and
Jaikumar BC et al., Sch Int J Anat Physiol, March 2019; 2(3): 128-131
© 2019 |Published by Scholars Middle East Publishers, Dubai, United Arab Emirates 129
laminated tags. Anatomy of the caudate lobe was
studied after defining and cleaning lesser omentum
covering its two of the four margins [7].
Each liver was placed in the anatomical
position to facilitate visualization of the diaphragmatic
and visceral surfaces, and morphometric measurements
were performed with the aid of cotton threads and
digital Vernier caliper in mm. Each liver was examined
on three different occasions by the examiner and the
mean of the three readings was derived. A line, L1 is
drawn through the right lateral wall of the main portal
vein. Another line, L2 was drawn parallel to L1 at the
most medial aspect of the caudate lobe. Another line,
L3 was drawn perpendicular to lines 1 and 2, midway
between Main Portal Vein and the inferior vena cava,
and extended out to the lateral margin of the right lobe.
For consistency, in the present study the most medial
aspect of the caudate lobe was considered as the medial
extent of the transverse diameter of the porta hepatis in
all livers [8, 9].
Visceral surface of the liver, demonstrating the greatest longitudinal diameter of the caudate lobe (CL) measured
supero-inferiorly. CT transverse diameter of the caudate lobe, IVC Inferior Vena Cava, MPV Main Portal Vein
CT – Transverse diameter of caudate lobe: Measured from the most medial margin of the caudate lobe to the right lateral
wall of the portal vein.
CL – Longitudnal diameter of caudate lobe: Measured at the level of the greatest longitudinal extension of the caudate
lobe.
Transverse diameter of the caudate lobe measured on L3 between L1 and L2
Jaikumar BC et al., Sch Int J Anat Physiol, March 2019; 2(3): 128-131
© 2019 |Published by Scholars Middle East Publishers, Dubai, United Arab Emirates 130
The distinct morphological characteristics
observed were recorded on individual data sheets in a
form appropriate for posthumous analysis [3].
The data was analyzed using descriptive
statistics (frequency, percentage, mean, median,
standard deviation, skewness and kurtosis) and
relational statistics i.e.‘Z’ test. Z’ test was computed to
find out the association between the parameters of the
present study and the studies of similar background
[10].
OBSERVATIONS AND RESULTS
In the present study, a total of 100 embalmed
human livers evacuated were studied, 18 livers (18%)
were normal in their external appearance. However, 82
(82%) specimens showed anomalies in lobes, fissures,
shape and size of lobe. On examining the caudate lobe
it was found that majority of the caudate lobes in all the
livers are rectangular 67 (67%) in shape followed by
pyriform 21 (21%) and irregular 12 (12%) shaped.
Table-1: Shape of Caudate lobe
Shape of Caudate lobe
Type of Shape
No. of Liver specimen
Percentage %
Rectangular
67
67
Pyriform
21
21
Irregular
12
12
The average transverse diameter of caudate
was measured 28.69 ± 7.73, while the values ranged
between 14.68–50.81. The mean is more than median
and S3 > 0, which indicate positively skewed
distribution of data because observations tend to
concentrate more at the lower end of the possible
values. The distribution is more spread out than normal
as kurtosis is less than 3 (platykurtic). The average
longitundal diameter of caudate lobe was measured
54.67 ± 10.73 and the values ranged between 35.41–
74.24. The mean is less than median and S3 < 0, which
indicate negatively skewed distribution of data because
observations tend to concentrate more at the higher end
of the possible values. The distribution is more spread
out than normal as kurtosis is less than 3 (platykurtic).
Table-2: Morphology of caudate lobe
Parameter
Mean (SD)
Median
Skewness
(S3)
Kurtosis
(S4)
Transverse Diameter (CT)
28.69
(7.73)
27.97
0.75
0.15
Longitudinal Diameter (CL)
54.97
(10.73)
56.23
-0.91
-1.07
Table-3: Morphology of Caudate Lobe comparing with other studies
Authors
Present
study
Sahni et
al., [11]
Ahidjo et
al., [12]
Chavan et
al., [13]
Arora
et al.,
[14]
Sagoo et al.,
[15]
Reddy et
al.,
[16]
Sample size
100
138
-
50
36
50
80
Transverse Diameter
of caudate lobe
28.69±7.73
32.7± 7.6
34.1± 6.5
25.0
27.0
27.4± 12.2
25.4
Longitudinal
diameter of caudate
lobe
54.97± 10.73
-
-
81.5
50.3
57.4± 14.1
47.8
DISCUSSION
An attempt was made to find out the variations
in the shape and size of caudate lobe to aid into clinical
and surgical applications.
The findings of the present study for shape of
caudate lobe are 67 (67%) rectangular, 21 (21%)
pyriform and 12 (12%) irregular. Sahni et al. studied
200 specimens of liver. They observed that 189 (94.5%)
were rectangular, 9 (4.5%) pyriform and 2 (1%)
irregular. Sagoo et. al. also studied 50 specimens of
liver for Northwestern Indian reported 45 (90%)
rectangular, 03 (6%) pyriform and 02 (4%) irregular
shapes of caudate lobe. In the Present study the average
transverse diameter of caudate was measured 28.69 ±
7.73, while the values ranged between 14.68–50.81 and
the average longitundal diameter of caudate lobe was
measured 54.67 ± 10.73 and the values ranged between
35.41–74.24. Such measurements were compared with
the studies done in the past as shown in Table-3.
CONCLUSION
A sound knowledge of the normal and
variations in liver anatomy is a prerequisite to having a
Jaikumar BC et al., Sch Int J Anat Physiol, March 2019; 2(3): 128-131
© 2019 |Published by Scholars Middle East Publishers, Dubai, United Arab Emirates 131
favorable clinical outcome. The commonly occurring
anatomical variations in liver have even more
significance in the era of diagnostic imaging and
minimally invasive surgical approaches. The absence of
normal fissures or the presence of additional lobes
might lead to confusion on a radiological diagnosis of a
liver disorder. The modern era of imaging and
minimally invasive liver surgeries have started after the
intrahepatic segmentary anatomy was classified. It is
very important on the part of both the radiologists and
surgeons to have a thorough knowledge of the normal
anatomy and the commonly occurring variations of this
organ. The success of liver transplantation points
towards an increase in liver operations in the future.
Conflict of Interest: None
ABBREVIATIONS
IVC: inferior vena cava
et.al: Et Alia (and others)
CT: Transverse diameter of caudate lobe
CL: Longitudinal diameter of caudate lobe
SD: Standard deviation
Authors' Contributions
JBC: Concept and design of study, Collection
of data, Acquisition of data, analysis & interpretation of
data, literature search, BBK: Concept and design of
study, analysis & interpretation of data, literature
search, drafting the article and final version to be
published. VHV: Concept and design of study,
Collection of data, Acquisition of data, analysis &
interpretation of data, literature search.
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