European Journal of Cardiovascular Medicine

The liver is the most massive of the viscera, occupying a substantial portion of the abdominal cavity1. It occupies whole of the right hypochondrium, upper part of the epigastrium and part of the left hypochondrium up to the left lateral plane2. It presents five surfaces - superior, anterior, right lateral, posterior and inferior surfaces. It is anatomically divided into larger right and a smaller left lobes by the attachment of falciform ligament on the anterior surface, the fissure for ligamentum venosum on the posterior surface and the fissure for ligamentum teres on the inferior surface in the 2nd month of intrauterine life. Failure of such separation into lobes may result in the fusion of lobes of the liver. The fissure for ligamentum teres is a deep cleft that usually extends from a notch on the inferior border of the liver to the left end of porta hepatis. The floor of this fissure lodges ligamentum teres hepatis, that is a remnant of obliterated left umbilical vein and extends up to the left branch of portal vein at the porta hepatis2. During the intrauterine life, it supplies oxygenated and nutrient rich blood from the placenta to the foetus3.

Clinically, the ligamentum teres is used for cannulation in various diagnostic and therapeutic procedures. Rarely, this fissure for ligamentum teres may be completely bridged by liver tissue converting the fissure into a tunnel or may be partially bridged leaving an incomplete fissure for the ligamentum teres. Such variation has been given different names – Pons hepatis4, Absent fissure for ligamentum teres5, Absent quadrate lobe6, Tunnel for ligamentum teres6,7. Shamir O. Cawich, et al have classified the anatomical variants of the fissure for Ligamentum teres into following types:

                                                            Table-1

Though some anomalies of liver such as presence of accessory lobes, etc. are occasionally seen, but the above-mentioned variations in the fissure for Ligamentum teres are rare, having clinical significance.  In the present study, we have identified such variations in the fissure for Ligamentum teres among the selected sample of liver specimens, which we have documented and reported with photographs.

The present study was carried out in 40 formalin fixed liver specimens in the department of Anatomy, Rangaraya Medical College, Kakinada which were removed from the adult human cadavers during routine dissection classes for the First year MBBS students and preserved in 10% formalin. Fissure for ligamentum teres was studied in these specimens and the identified variations were noted and reported. Photographs of the specimens with variations were captured during the course of the study.

We have observed 40 liver specimens that were removed from the cadavers during routine dissection for the Undergraduate students and preserved in 10% formalin. Out of these 40 specimens, 12 showed different variations in the fissure for Ligamentum teres hepatis. Remaining 28 specimens had normal, anatomical fissure for Ligamentum teres.

                                                                                          Table-2

Chart-1

Chart-2