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Clinical Nuclear Medicine Aug 2021A 52-year-old woman previously treated for a stage IIIc high-grade ovarian serous carcinoma presented right upper quadrant abdominal pain, 3 years after extended surgery...
A 52-year-old woman previously treated for a stage IIIc high-grade ovarian serous carcinoma presented right upper quadrant abdominal pain, 3 years after extended surgery and chemotherapy. Abdominal CT, MRI, and 18F-FDG PET/CT showed a right hepatic mass, consistent for lone recurrence nearby the hepatic lateral fissure. Preoperative and histologic examination identified a peritoneal lateral fissure lesion. The patient underwent atypic segment 5 segmentectomy. She has been disease-free for 3 years now. Advanced ovarian cancer can be responsible for perihepatic sulcus lesions, such as this right fissure lesion. They should not be mistaken for inoperable parenchyma metastases.
Topics: Diagnosis, Differential; Female; Fluorodeoxyglucose F18; Humans; Liver Neoplasms; Middle Aged; Ovarian Neoplasms; Peritoneal Neoplasms; Positron Emission Tomography Computed Tomography
PubMed: 34186543
DOI: 10.1097/RLU.0000000000003675 -
BMC Surgery Dec 2021Liver tumours between the root angle of the middle and right hepatic veins are a special type of liver segment VIII tumour. In this study, we designed a modified median...
BACKGROUND
Liver tumours between the root angle of the middle and right hepatic veins are a special type of liver segment VIII tumour. In this study, we designed a modified median hepatic fissure approach to remove these tumours. The safety and effectiveness of the approach were evaluated.
MATERIALS AND METHODS
From April 2015 to November 2019, 11 patients with liver tumours between the angle of the middle and right hepatic veins underwent this modified median hepatic fissure approach. We retrospectively analysed data from the perioperative periods of these 11 patients, including general condition, operation time, intraoperative bleeding, and postoperative complications. Disease-free survival and overall survival were assessed.
RESULTS
Of the 11 patients, 9 patients had primary hepatocellular carcinoma and 2 had colorectal liver metastases. The average intraoperative blood loss was 285 mL (150-450 mL). Two patients developed postoperative bile leakage, but there were no significant serious complications, such as intraabdominal bleeding and liver failure, in any of the patients. The liver function returned to the normal range on the 5th day after surgery. Of the 11 patients, 5 have survived for more than 3 years (45.5%), and 4 have been disease-free for more than 3 years (36.3%).
CONCLUSIONS
For liver tumours between the root angle of the middle and right hepatic veins, the modified median hepatic fissure approach is a safe and feasible method.
Topics: Blood Loss, Surgical; Carcinoma, Hepatocellular; Hepatectomy; Hepatic Veins; Humans; Liver Neoplasms; Retrospective Studies
PubMed: 34861838
DOI: 10.1186/s12893-021-01412-y -
The Surgical Clinics of North America Apr 2004The liver, the largest organ in the body, has been misunderstood at nearly all levels of organization, and there is a tendency to ignore details that do not fit the... (Review)
Review
The liver, the largest organ in the body, has been misunderstood at nearly all levels of organization, and there is a tendency to ignore details that do not fit the preconception. A complete presentation of the surgical anatomy of the liver includes the study of hepatic surfaces, margins, and fissures; the various classifications of lobes and segments; and the vasculature and lymphatics. A brief overview of the intrahepatic biliary tract is also presented.
Topics: Hepatectomy; Hepatic Artery; Hepatic Veins; Humans; Ligaments; Liver; Portal Vein; Vena Cava, Inferior
PubMed: 15062653
DOI: 10.1016/j.suc.2003.12.002 -
ANZ Journal of Surgery Jul 2021The umbilical fissure vein (UFV) is a hepatic vein that travels within the umbilical fissure (or its proximity), providing venous drainage for hepatic segments 3 and 4....
BACKGROUND
The umbilical fissure vein (UFV) is a hepatic vein that travels within the umbilical fissure (or its proximity), providing venous drainage for hepatic segments 3 and 4. Its preservation carries a potential importance in extended right hemi-hepatectomy, left lateral segmentectomy and extended segment 2 resections.
METHODS
Consecutive 1-mm slice thickness portovenous phase intravenous contrast computed tomography (CT) scans of the abdomen performed were retrospectively reviewed during the period of June 2019 to July 2019, with two independent investigators investigating the presence of UFV, its course, insertion and relation to the umbilical fissure.
RESULTS
A total of 244 CTs were identified and 186 included. The UFV was identified on 72.8% of participants, 109 (81.4%) drained into the main left hepatic vein, while the remaining ones drained either from the main middle hepatic vein (16.4%) or the bifurcation between main left and middle hepatic vein (2.2%). The veins course lay 2 mm or less along the length of umbilical fissure in 39.5%, while 57.5% ran within 1 cm along the length of the umbilical fissure.
CONCLUSION
Pre-operative identification of UFV could assist in operative planning. The vein can be used as a landmark in surgery and should be preserved in left lateral segmentectomy and extended right hepatectomy to avoid parenchymal congestion of remnant segments.
Topics: Hepatectomy; Hepatic Veins; Humans; Liver; Portal Vein; Retrospective Studies
PubMed: 34031976
DOI: 10.1111/ans.16963 -
AJR. American Journal of Roentgenology Jun 1985
Topics: Humans; Liver Diseases; Radiography
PubMed: 3873818
DOI: 10.2214/ajr.144.6.1314 -
Surgical and Radiologic Anatomy : SRA May 2021In the classical description of normal liver anatomy, the umbilical fissure is a long, narrow groove that receives the ligamentum teres hepatis. The pons hepatis is an...
PURPOSE
In the classical description of normal liver anatomy, the umbilical fissure is a long, narrow groove that receives the ligamentum teres hepatis. The pons hepatis is an anatomic variant, where the umbilical fissure is converted into a tunnel by an overlying bridge of liver parenchyma. We carried out a study to evaluate the existing variations of the umbilical fissure in a Caribbean population.
METHODS
We observed all consecutive autopsies performed at a facility in Jamaica and selected cadavers with a pons hepatis for detailed study. A pons hepatis was considered present when the umbilical fissure was covered by hepatic parenchyma. We recognized two variants: an open-type (incomplete) pons hepatis in which the umbilical fissure was incompletely covered by parenchyma ≤ 2 cm in length and a closed type (complete) pons hepatis in which the umbilical fissure was covered by a parenchymal bridge > 2 cm and thus converted into a tunnel. We measured the length (distance from transverse fissure to anterior margin of the parenchymatous bridge), width (extension across the umbilical fissure in a coronal plane) and thickness (distance from the visceral surface to the hepatic surface measured at the mid-point of the parenchymal bridge in a sagittal plane) of each pons hepatis. A systematic literature review was also performed to retrieve data from relevant studies. The raw data from these retrieved studies was used to calculate the global point prevalence of pons hepatis and compared the prevalence in our population.
RESULTS
Of 66 autopsies observed, a pons hepatis was present in 27 (40.9%) cadavers. There were 15 complete variants, with a mean length of 34.66 mm, mean width of 16.98 mm and mean thickness of 10.98 mm. There were 12 incomplete variants, with a mean length of 17.02 mm, width of 17.03 mm and thickness of 9.56 mm. The global point prevalence of the pons hepatis (190/5515) was calculated to be or 3.45% of the global population.
CONCLUSIONS
We have proposed a classification of the pons hepatis that is reproducible and clinically relevant. This allowed us to identify a high prevalence of pons hepatis (41%) in this Afro-Caribbean population that is significantly greater than the global prevalence (3.45%; P < 0.0001).
Topics: Aged; Aged, 80 and over; Anatomic Variation; Cadaver; Female; Humans; Jamaica; Liver; Male; Middle Aged; Prevalence; Round Ligaments
PubMed: 33538876
DOI: 10.1007/s00276-021-02688-8 -
AJR. American Journal of Roentgenology Sep 1987The inferior accessory hepatic fissure, a coronal or parasagittal fissure through the parenchyma of the posterior segment of the right hepatic lobe, was observed...
The inferior accessory hepatic fissure, a coronal or parasagittal fissure through the parenchyma of the posterior segment of the right hepatic lobe, was observed sonographically in 15 of 2000 patients. The fissure was seen as a thin, echogenic membrane stretching downward from the right branch of the portal vein to the inferior surface of the right hepatic lobe. On cadaveric sections, the fissure was an invagination of peritoneum directed laterally and slightly posteriorly from the medial inferior surface of the right hepatic lobe below the porta hepatis.
Topics: Humans; Liver; Ultrasonography
PubMed: 3303876
DOI: 10.2214/ajr.149.3.495 -
Japanese Journal of Radiology Jul 2012The left hepatic lobe is divided into three subsegments according to anatomical landmarks; however, there are several variations in the vascular territories of the left... (Review)
Review
The left hepatic lobe is divided into three subsegments according to anatomical landmarks; however, there are several variations in the vascular territories of the left hepatic arterial branches. Hepatocellular carcinoma (HCC) located near the umbilical fissure or at the left side of the umbilical portion of the left portal vein has frequent crossover blood supply. HCC located in the caudal aspect of the lateral segment has a variety of feeding arteries, and is infrequently supplied by the caudate artery or the medial subsegmental artery (A4), and by the lateral left hepatic arteries. HCC located in the posterior aspect of segment 4 is frequently supplied by the caudate artery or a small A4 branch arising from the caudate artery. In addition, the left inferior phrenic, right and left internal mammary, right and left gastric, cystic, and omental arteries are well known extrahepatic collateral pathways supplying HCC in the left hepatic lobe, especially when the hepatic artery is attenuated by previous transcatheter arterial chemoembolization (TACE). Interventional radiologists should have sufficient knowledge of vascular territories in the left hepatic arterial branches and extrahepatic collaterals to perform effective TACE for HCC located in the left hepatic lobe.
Topics: Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Hepatic Artery; Humans; Liver; Liver Neoplasms; Portal Vein; Radiology, Interventional; Tomography, X-Ray Computed
PubMed: 22476846
DOI: 10.1007/s11604-012-0075-6 -
The British Journal of Radiology Dec 2002Hepatic capsular retraction adjacent to hepatic tumour is rare, although this finding has been described in a variety of malignant tumours and haemangioma. The authors... (Review)
Review
Hepatic capsular retraction adjacent to hepatic tumour is rare, although this finding has been described in a variety of malignant tumours and haemangioma. The authors have seen various causes of hepatic capsular retraction associated with hepatic tumours, including a variety of malignant tumours, haemangioma and post-treatment of malignant tumours, as well as cases not associated with a hepatic tumour, including confluent hepatic fibrosis, oriental cholangiohepatitis and bile duct necrosis. Furthermore, causes of pseudoretraction of the hepatic capsule, including accessory fissure and normal liver parenchyma between the protruded masses, are described.
Topics: Adult; Aged; Female; Humans; Liver; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Necrosis; Tomography, X-Ray Computed
PubMed: 12515710
DOI: 10.1259/bjr.75.900.750994 -
Swiss Surgery = Schweizer Chirurgie =... 1999The detailed knowledge of the segmental anatomy of the liver has led to a rapid evolution in resectional surgery based on the intrahepatic distribution of the portal... (Review)
Review
The detailed knowledge of the segmental anatomy of the liver has led to a rapid evolution in resectional surgery based on the intrahepatic distribution of the portal trinity (the hepatic artery, hepatic duct and portal vein). The classical intrafascial or extrahepatic approach is to isolate the appropriate branch of the portal vein, hepatic artery and the hepatic duct, outside the liver substance. Another method, the extrafascial approach, is to dissect the whole sheath of the pedicle directly after division of a substantial amount of the hepatic tissue to reach the pedicle, which is surrounded by a sheath, derived from Glisson's capsule. This Glissonian sheath encloses the portal trinity. In the transfissural or intrahepatic approach, these sheaths can be approached either anteriorly (after division of the main, right or umbilical fissure) or posteriorly from behind the porta hepatis. We describe the technique for approaching the Glissonian sheath and hence the hepatic pedicle structures and their branches by the intrahepatic posterior approach that allows early delineation of the liver segment without the need for ancillary techniques. In addition, the indications for the use of this technique in the technical and oncologic settings are also discussed.
Topics: Digestive System Surgical Procedures; Humans; Liver
PubMed: 10414187
DOI: 10.1024/1023-9332.5.3.143