Abnormal localization of gallbladder and atresia of superior part of duodenum

Year 2008, Volume: 15 Issue: 1, 38 - 41, 11.05.2009

Necdet Kocabıyık Fatih Yazar Bülent Yalçın Hasan Ozan

Abstract

Süleyman Demirel Üniversitesi
TIP FAKÜLTESİ DERGİSİ: 2008 Mart; 15 (1)



Abnormal localization of gallbladder and atresia of superior part of duodenum



Necdet Kocabıyık, Fatih Yazar, Bülent Yalçın, Hasan Ozan



Gülhane Askeri Tıp Akademisi, Anatomi Ana Bilim Dalı



Özet



Safra kesesinin anormal lokalizasyonu ve duodenum.un superior parçasının atrezisi



Elli yaşında erkek bir kadavrada, duodenum.un superior parçasının atrezisiyle birlikte safra kesesinin de anormal lokalizasyonlu olduğunu gördük. Karaciğerin sağ lobunun alt tarafında 58x49x36 mm boyutlarında bir kavite vardı. Bu kavitenin derininde, safra kesesi karaciğere gömülü olarak bulunuyordu. Bu kavite tamamen omentum majus.un bir bölümüyle örtülüydü. Omentum majus kaldırıldığında, kavitenin mideye bakan tarafında pilorik ostium, duodenuma bakan tarafında ise duodenal ostium görüldü. Kavitenin bu bölgesine uyan duodenumun superior parçasının atrezik olduğu saptandı. Bu kadavranın normal yaşamında, duodenum.un superior parçası ve bulbus duodeni.nin yokluğu nedeniyle, mide içeriği pilorik ostium aracılığıyla kaviteye, duodenum ostiumu aracılığıyla da duodenuma geçtiği varsayıldı. Farklı yerleşim gösteren safra kesesi, deneyimsiz cerrahlar, gastroenterologlar ve radyologlar tarafından yapılan laparoskopik girişimler ve radyolojik değerlendirmeler sırasında hataya yol açabilir.



Anahtar kelimeler: Karaciğer, safra kesesi, duodenal atrezi, gelişimsel anomali



Abstract



This article presents abnormal localization of gallbladder with atresia of superior part of duodenum in a 50 year-old-male cadaver. On inferior side of right lobe of the liver was a cavity with diameters of 58x49x36 mm. At the bottom of this cavity the gallbladder was embedded the liver. This cavity was completely covered with a part of the greater omentum. When the greater omentum was removed, we observed ostium of pylor on the gastric side and the ostium of duodenum on the duodenal side of the cavity. It was observed that there was atresia of superior part of duodenum corresponding to the region of the cavity. In the normal life of this cadaver, because of the absence of superior part of duodenum and bulbus duodeni, gastric content was pouring into this cavity through the pyloric ostium and into duodenum through the duodenal ostium of the cavity. Unusual settlement of the gallbladder may lead inexperienced surgeons and radiologists into error during laparoscopic interventions or radiological assessments. Variant settlement of the gallbladder may lead inexperienced surgeons, gastroenterologists and radiologists into error during laparoscopic interventions or radiological assessments.



Keywords: Liver, gallbladder, duodenal atresia, developmental abnormality.

Keywords

Karaciðer, safra kesesi, duodenal atrezi, geliþimsel anomali

References

• Ladd AP, Madura JA. Congenital duodenal anomalies
• in the adult. Arch Surg 2001; 136(5): 576-84.
• Senecail B, Nonent M, Kergastel I, Patin-Philippe L, Larroche P, Le Borgne A. Ultrasonic features of congenital anomalies of the gallbladder. J Radiol 2000; 81(11): 1591-4.
• Azmat N, Francis KR, Mandava N, Pizzi WF. Agenesis of the gallbladder revisited laparoscopically. Am J Gastroenterol 1993; 88: 1269-70.
• Principe A, Spangaro M, Lapilli A, Vecchi R, Volta L, De Lorenzi P. Congenital anomalies of the gallbladder. A case of retrohepatic gallbladder contained in the coronary ligament. Minerva Chir 1979; 34: 879- 84.
• Alawaneh I. Anomaly of the gallbladder lying extraperitoneally in the internal oblique muscle: report of an unusual case. Int Surg 1979; 64(6): 45-7.
• Labitzke R. Congenital intrathoracic ectopic gallbladder, a currently unreported developmental disorder. Attempt at a classification of abnormal gallbladder sites. Chirurg 1991; 62(10): 755-8.
• Sinnatamby CS. Last’s Anatomy Regional And Applied, 10th ed. Churchill Livingstone, London, UK, 1999: 395–397.
• Lynn, H.B., Espinas, E.E.: Intestinal atresia. Arch Surg 79: 357, 1959.
• Boyden EA, Cope JG, Bill AH Jr. Anatomy and embryology of congenital intrinsic obstruction of the duodenum. Am J Surg 1967; 114: 190-202.
• Naganuma S, Ishida H, Konno K, Hamachima Y, Hoshino T, Naganuma H. Sonographic findings of anomalous position of the gallbladder. Abdom Imaging 1998; 23: 67-72.
• Turkel SB, Swanson V, Chandrasoma P. Malformations associated with congenital absence of the gallbladder. J Med Genet 1983; 20: 445-449.
• Raule M, Bagni CM, Marinoni M, Meroni M, Perazzoli G, Trivellini G. Agenesis of the gallbladder in adults: A diagnostic problem. Br J Surg 1994; 81: 676.
• Knechtle SJ, Filston HC. Anomalous biliary ducts associated with duodenal atresia. J Pediatr Surg 1990; 25(12): 1266-9.
• Coquaz S, Bruant P, Regenet N, Lermite E, Pessaux P, Arnaud JP. Gallbladder volvulus: two cases report. Ann Chir 2005; 130: 252–253.
• Fujishiro E, Suzuki Y, Sato T, Kondo S, Miyachi M, Suzumori K. Characteristic findings for diagnosis of baby complicated with both the VACTERL association and duodenal atresia. Fetal Diagn Ther 2004; 19(2): 134-137.