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A Study of Variations in the Position of Fundus and Peritoneal Reflections of Gall Bladder |
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D Sreelekha, S Swayam jothi Dorairaj, Rajeswar Rao, K Maheswari 1. Assistant Professor, Department of Anatomy, Sree Balaji Medical College and Hospital, Chrompet, Chennai, India. 2. Professor and Head of Department, Department of Anatomy, Shri Sathya Sai Medical College, Kancheepuram, Tamilnadu, India. 3. Assistant Professor, Department of Anatomy, Shri Sathya Sai Medical College, Kancheepuram, Tamil Nadu, India. 4. Professor and Head of Department, Department of Anatomy, Meenakshi Medical College, Hospital and Research Institute, Chennai, India. |
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Correspondence Address : Dr. S. Swayam Jothi Dorairaj, No.15/7, 3rd Canal Cross Road, Gandhinagar, Adyar, Chennai-600020, Tamilnadu, India. E-mail: swayamjothi@gmail.com |
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| ABSTRACT |  | ||||||||||||||||||||||||||||||||||||
: Morphometry of body and neural arch of lumbar vertebrae is very crucial in manufacturing screws, interspinous implants as well as preoperative planning of surgeries involving dorsolumbar spine. Aim: To determine various dimensions of typical and atypical lumbar vertebrae. Materials and Methods: A descriptive osteological study was carried out which included 66 intact adult dry human lumbar vertebrae (53 typical and 13 atypical) which were free of any deformity or pathological features. All the 53 typical vertebrae were randomly obtained. The following parameters were measured with slide callipers- superior transverse diameter and superior antero-posterior diameters of vertebral foramen; transverse diameter, antero-posterior diameter and anterior height of vertebral body; width, height of pedicles; interpedicular distance; maximum thickness of lamina; length of transverse process; maximum length, maximum height and maximum central thickness of spinous process. The data was tabulated and analysed using Microsoft Excel software. Mean and standard deviation was calculated for each parameter. Unpaired t-test was applied and p-value was derived for parameters like width and height of pedicles, thickness of lamina and length of transverse process. The p-value<0.05 were considered as significant. Results: The vertebral foramen (superior transverse diameter- 20.41±2.54 mm, superior antero-posterior diameter- 13.3±2.04 mm); vertebral body (transverse diameter- 44.43±5.91 mm, antero-posterior diameter- 30.17±3.19 mm, anterior height- 24.01±1.84 mm); pedicle (width- 10.85±3.94 mm on left side and 11.04±4.01 mm on right side, height- 13.84±4.01 mm on left side and 13.8±1.93 mm on right side, interpedicular distance- 29.17±5.06 mm); lamina (thickness- 6.6±1.36 mm on left side and 6.85±1.34 mm on right side); transverse process (length- 20.94±4.01 mm on left side and 21.51±4.5 mm on right side); spinous process (maximum length- 26.01±3.73 mm, maximum height- 19.92±4.03 mm, maximum central thickness- 6.42±1.41 mm). The mean transverse diameter and antero-posterior diameter of vertebral foramen of atypical lumbar vertebrae were higher than those of the typical lumbar vertebrae and these differences were significant (p-value of 0.0001 for transverse diameter and p-value of 0.005 for antero-posterior diameter). Conclusion: Most of the parameters of atypical lumbar vertebrae were found to be more compared to those of typical lumbar vertebrae. This inference should be kept in mind during fixation of lumbar inter-spinous implants, designing of pedicular screws and spinal grafting. | |||||||||||||||||||||||||||||||||||||
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| Keywords : Biliary tract, Cholecystectomy, Laparoscopy, Liver | |||||||||||||||||||||||||||||||||||||
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| INTRODUCTION |
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Gall bladder is flask shaped and is usually firmly attached by connective tissue to the inferior surface of the right lobe of the liver. It is located on the inferior surface of liver and is covered by peritoneum (1). Its upper surface is attached to the liver by connective tissue, elsewhere it is completely covered by peritoneum continued from the hepatic surface. Occasionally it is completely invested by peritoneum and even connected to the liver by a short mesentery (2). Rarely the gall bladder itself may be embedded within the liver (3). The reflection of peritoneum varies widely. At one extreme, the gall bladder may be intrahepatic having no peritoneal covering, whereas on the other end, it may hang freely by a mesentery (4),(5). The gall bladder consists of the fundus, body, infundibulum and neck. The fundus is a bulbous blind end, which usually projects a little beyond the sharp inferior border of the liver and touches the parietal peritoneum of the anterior abdominal wall at the tip of the ninth costal cartilage, where the transpyloric plane crosses the right costal margin, at the lateral border of the right rectus sheath (3). The fundus of the normal gall bladder is not palpable but may become so if distended by biliary tract obstruction. The body passes backwards and upwards and tapers towards the neck, which lies in the porta hepatis (3),(6). The biliary tract is one of the most frequent sites of operative intervention, with an estimated 8,50,000 biliary tract procedures performed every year in India (7). Cholecystectomy is the most common operative procedure performed on biliary tract (8). It is the single most common intra abdominal operative procedure and it is estimated that about 4,50,000 cholecystectomies were performed annually (9). Few studies state that the extra hepatic biliary tract does not have a normal anatomy and instead presents with a common pattern of variations (10),(11). While doing routine dissection for undergraduate teaching we came across liver and gall bladder specimens with different positions of the fundus and varying peritoneal reflections with free hanging gall bladders. As, a free hanging gall bladder can lead to surgical emergencies, study aimed at observing the occurrence of this variation along with the position and extent of the fundus. Hence, this study was undertaken to observe various positions of the fundus and length in relation to and beyond the inferior border of liver. Also various peritoneal relations of the gall bladder were studied. | |||||||||||||||||||||||||||||||||||||
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| TABLES AND FIGURES |
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Original article / research
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