Situs inversus totalis – A rare case

Situs inversus totalis – A rare case

S92 Abstracts / Journal of the Anatomical Society of India 66S (2017) S79–S125 et al. (2005) investigated arteries supplying floor of the mouth and t...

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Abstracts / Journal of the Anatomical Society of India 66S (2017) S79–S125

et al. (2005) investigated arteries supplying floor of the mouth and tongue gross anatomically using 101 sides of 53 cadavers. The courses were divided into 3 categories in relation to hyoglossus: those passing medial (M) had usual pattern of distribution or lateral to it (L) and piercing mylohyoid (P). In categories L and P sublingual artery arose from facial or submental artery and regarded as unusual types. Hence it is concluded that the knowledge of variant origin of sublingual artery will contribute to safer dental implant surgery and more accurate interpretation of angiographic images of arteries in the floor of mouth. Conflicts of interest The authors have none to declare. http://dx.doi.org/10.1016/j.jasi.2017.08.288 43 Meandering loop of inferior epigastric artery in inguinal canal C.S. Ramesh Babu ∗ , Vinay Sharma Muzaffarnagar Medical College, Muzaffarnagar, India Background: Inferior epigastric artery or deep inferior epigastric artery as clinicians prefer to call, has gained lot of attention because of its injury while performing various percutaneous anterior abdominal wall interventional procedures. Originating as a branch of external iliac, it runs superomedially along the medial border of deep inguinal ring to enter rectus sheath. Earlier combined cadaveric and radiographic studies on 244 cases have indicated that the artery did not show anomalies. Material and methods: Out of 24 cadavers used for routine dissection we have observed anomalous course of inferior epigastric artery in the inguinal canal in a male cadaver. Observations: An anomalous meandering loop of inferior epigastric artery extending medially in the posterior wall of inguinal canal was observed bilaterally in a male cadaver. From its origin the artery turned horizontally medially in the extra peritoneal fat and then turned upwards after forming a loop. The loop was 38.42 mm away from the midline on right side and 41.02 mm on the left side. After entering the rectus sheath the artery ran vertically along the lateral border of rectus abdominis for a short distance before passing posterior to muscle. Conflicts of interest The authors have none to declare. http://dx.doi.org/10.1016/j.jasi.2017.08.289 44 Cystoduodenal ligament with hepatic artery variation Chiman Kumari ∗ , Chandanlal Gupta, Pooja Jain, Khursheed Raza, Saroj Kaler Jhajhri, Seema Singh, Neerja Rani AIIMS, New Delhi, India Background: Variable arrangement of peritoneum results in formation of unexpected peritoneal bands and is important to know every such variation in the human body for any interventional procedures. Complex development of the peritoneum and

gastrointestinal tract may lead to such aberrant folds or recesses. Cystoduodenal ligament is one of such abnormal fold of peritoneum between the gallbladder and the duodenum. This aberrant pattern of peritoneal folds may contain important vessels like cystic or hepatic artery which may or may not be symptomatic. This may become symptomatic due to disease processes, malignancies and surgical interventions. In the present case, a double fold of peritoneum was observed between the neck of the gall bladder and first part of the duodenum along with a variable distribution pattern of hepatic artery. Materials and methods: An elderly male cadaver was dissected during undergraduate teaching in the department of Anatomy, AIIMS, New Delhi. Result: A well-defined cystoduodenal ligament was observed along with a variable pattern of hepatic artery. The ligament was extending from neck of the gall bladder to the first part of duodenum. One of the hepatic arteries was arising directly while the other two were arising as a common trunk from the common hepatic artery. Conclusion: The abnormal cystoduodenal ligament may compress the neck of gall bladder or the cystic duct causing obstruction in the flow of bile. Knowledge of the branching pattern of the hepatic artery is warranted before and during biliary interventions to avoid intraoperative and post-operative complications. Discussion: Looped course of inferior epigastric artery in the posterior wall of inguinal canal has not been reported in literature. Catastrophic consequences can occur if a surgeon is caught unaware of an anomalous vessel during laparoscopic inguinal hernia repair. Conflicts of interest The authors have none to declare. http://dx.doi.org/10.1016/j.jasi.2017.08.290 45 Situs inversus totalis – A rare case D. Meher ∗ , C. Sarangi, R.K. Das, M. Panda, C. Mohapatra SCB Medical College and Hospital, Cuttack, Odisha, India Introduction: Situs inversus totalis is a congenital positional anomaly characterized by transposition of abdominal viscera associated with dextrocardia (right sided heart). The report showed that dextrocardia with situs inversus existing in one in ten thousand population. Mathew Baillie who was first described situs inversus totalis in early twentieth century. The term situs inversus is a short form of Latin meaning inverted position of the internal organs. Usually individuals with situs inversus totalis are asymptomatic and have a normal life expectancy. Many people with situs inversus totalis are unaware of their unusual anatomy until they seek medical attention for an unrelated condition. The reversal of the organs may lead to some confusion as many signs and symptoms will be on the reverse side. Observation: A 43 years old male patient reported to the Department of Medicine, S.C.B. Medical College and Hospital, Cuttack, with the C/O epigastric pain and gastro-esophageal reflux since one month. The chest X-ray, ultrasonography and CT scan were done and he was diagnosed as situs inversus totalis.

Abstracts / Journal of the Anatomical Society of India 66S (2017) S79–S125

Conflicts of interest The authors have none to declare. http://dx.doi.org/10.1016/j.jasi.2017.08.291 46 Bicornuate uterus: A case report Deepak Sharma ∗ , Vandana A. Sharma, Sonia S. Baweja, Ankit Jain GMC, Bhopal, India Introduction: Uterine anomalies are uncommon and are known to influence reproductive outcomes. The incidence of congenital uterine malformation is estimated to be 3–5%. A bicornuate uterus is commonly referred to as a “heart-shaped” uterus composed of two “horns” separated by a septum. Materials and methods: During routine dissection for undergraduate teaching in the Department of Anatomy, Gandhi Medical College, Bhopal (MP) a bicornuate uterus was found, removed in to, dissected and measurements taken. Results: Bicornuate uterus with normal tubes and ovaries was found during dissection. External features shows heart shaped bilobbed uterus with indentation in the cranio-central part with central groove extending from posterior to anterior surface of uterus. Inspection through external os shows complete septum attached to internal os. On probing, two separate right and left side opening extending towards right and left cornua of uterus seen. Right and left cornua measures 4 cm (width), 3.5cm (length) and 4.5 cm, 4.0 cm respectively. Openings of right and left cornu were 3.9 cm above external os. Thickness of septum was 1.9 cm. Discussion: Bicornuate uterus results from abnormal development of the paramesonephric ducts. There is partial failure of fusion of ducts, resulting in a uterus divided into two horns. 15% to 25% cases have problems with fertility and reproduction. With the introduction of radiological diagnostic techniques reproductive outcomes can be improved with better diagnosis and treatment. Conflicts of interest The authors have none to declare. http://dx.doi.org/10.1016/j.jasi.2017.08.292 47 Tongue like projection of the left lobe of liver – A case report Kumar Dharmendra ∗ , R. Gurudiwan, C. Sarangi, C. Mohapatra SCB Medical College, Cuttack, Odisha, India Introduction: The liver which is the largest abdominal viscus of human body, usually has a larger right lobe and a smaller left lobe. Numerous variations have been mentioned in different literatures such as abnormal shape, accessory lobes, abnormal fissures, abnormal shape and position of gall bladder, Riedel’s lobe (which is a tongue like projection of right lobe of liver). The tongue like projection of left lobe of liver has rarely been mentioned in literature. Aims and objectives: Our aim is to highlight the anatomical variation of the left lobe of liver, which would be beneficial for anatomists, surgeons and radiologists. Materials/methods and observations: During routine undergraduate dissection of abdomen of a 45 year old female cadaver, an

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enlarged liver with tongue like projection of left lobe was observed. The liver occupied right hypochondrium, epigastrium and almost whole of left hypochondrium. The liver had a tongue like projection present in left lobe, 2–3 fissures on inferior/visceral surface of the left lobe and one prominent fissure on diaphragmatic surface dividing the left lobe into two parts. Conclusion: Hepatic variations such as accessory lobes, fissures etc. are very important for surgeons in planning biliary surgery, Porto systemic anastomosis, liver transplant etc. This variation is also useful for radiologists which should be kept in mind while diagnosing cases by USG, CT Scan, MRI etc. Conflicts of interest The authors have none to declare. http://dx.doi.org/10.1016/j.jasi.2017.08.293 48 Case report of infrequent variation of third head of biceps brachii muscle Divya Chavda ∗ , Meghana Joshi, Bhavin Kodiyatar, Ila Sutterwala Government Medical College Baroda, Gujarat, India Introduction: During the routine formalin fixed cadaveric dissection of right arm of 65 year old male in the Department of Anatomy, Medical College Baroda; we observed a supernumerary head of biceps brachii muscle which is one of the muscle of anterior compartment of arm. Observation: It has two head, short and long head. Short head arises from the tip of the coracoid process of scapula and long head arises from the supraglenoid tubercle of humerus. The third head arises from the lower two-third of the medial side of brachialis muscle and fuses with the tendon of biceps brachii. The muscle was innervated by musculocutaneous nerve, and all other related structure was studied. The unusual course of the musculocutaneous nerve without piercing to the corachobrachialis muscle was observed. The nerve passed between the biceps and brachialis muscle and continued as lateral cutaneous nerve of forearm. Conclusion: Knowledge of such variation is important because the third head may provide additional strength to biceps during supination of forearm and elbow flexion irrespective of shoulder position. The presence of the variations may cause bone displacement subsequent to fracture. This variation may help to the surgeons while operating on the arm and to clinicians for diagnosing the nerve impairment. Conflicts of interest The authors have none to declare. http://dx.doi.org/10.1016/j.jasi.2017.08.294