Urachal remnants presenting as an umbilical sinus in middle age: a rare case report

Urachal sinus is a rare type of Vitello intestinal duct anomalies. Clinical presentation is that of persistent umbilical discharge. It is usually seen in paediatric age group. Moreover, they have a different course in adults than paediatric age group in which they frequently involute and have a benign course. These remnants are prone to infection and development of malignancy. A proper diagnostic workup by clinical and imaging tools is required. Early removal of urachal remnants at first diagnosis is key for preventing future morbidities. In our case, all the three remnants (Vitello intestinal duct, urachus and ligamentum venosum) were found in a middle-aged patient and hence is unusual and a rare presentation.

Hypoplastic Left Lobe of Liver with Accessory Caudate Lobe

During routine dissection, a liver from a cadaver of a female aged 50 years was observed to have hypoplastic left lobe, and on posterior surface an accessory caudate lobe was present to the left of main caudate lobe. It was separated by well-defined fissure from caudate lobe. The fissure for ligamentum venosum was present to the left of accessory caudate lobe. Porta hepatis was present below the new lobe. Prominent papillary process continued with caudate process which in turn is fused with right lobe of the liver. These developmental anomalies of liver may cause confusion during procedures like biopsy, transplantation, and lobectomies. This knowledge may be of immense use to clinicians for the diagnosis and management of hepatic diseases, morphologists and anatomists for new variant, and to embryologists for new developmental defect.

Accessory hepatic artery: incidence and distribution

Background: Anatomic variations of the hepatic arteries are common. Preoperative identification of these variations is important to prevent inadvertent injury and potentially lethal complications during open and endovascular procedures. Objective: To evaluate the incidence, extra-hepatic course, and presence of side branches of accessory hepatic arteries, defined as an additional arterial supply to the liver in the presence of normal hepatic artery. Methods: Eighty-four human male cadavers were dissected using a transperitoneal midline laparotomy. The supra-celiac aorta, celiac axis, and hepatic arteries were dissected, and their trajectories were identified to describe arterial branching patterns. Results: Normal hepatic arterial anatomy was identified in 95% of the cadavers and six (5%) had accessory hepatic arteries. In five cadavers the accessory hepatic artery followed its course through the fissure for ligamentum venosum, and in one it coursed adjacent to the hepatic artery through the margin of the lesser omentum. One cadaver had a single side branch, which provided arterial blood supply to the left adrenal gland in the absence of any left inferior phrenic artery. Conclusion: Accessory hepatic artery most often follows the course of the hepatic fissure for ligamentum venosum. Albeit uncommonly found in 5% of cases, this finding should be identified during open and endovascular procedures to prevent inadvertent injury.