Hepatic surface grooves in Trinidad and Tobago
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ORIGINAL ARTICLE
Hepatic surface grooves in Trinidad and Tobago Shamir O. Cawich1 · Reyad R. A. Ali1 · Michael T. Gardner2 · Janet Charles1 · Sherrise Sandy1 · Neil W. Pearce3 · Vijay Naraynsingh1 Received: 15 June 2020 / Accepted: 23 July 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Purpose Hepatic surface grooves (HSGs) are prominent depressions on the antero-superior surface of the liver. We sought to document the prevalence of HSGs in an Eastern Caribbean population. Methods We observed all consecutive autopsies performed at a facility in Trinidad and Tobago and recorded the presence, number, location, width, length and depth of any HSG identified. Each liver was then sectioned to document intra-parenchymal abnormalities. Results Sixty Autopsies were observed. There were HSGs in 9 (15%) cadavers (5 females and 4 males), at an average age of 66 years (range 48–83, Median 64, SD ± 10.4). The HSGs were located on the diaphragmatic surface of the right hemi-liver in 8 (89%) cadavers, left medial section in 4 (44%), left lateral section in 3 (33%) and coursing along Cantlie’s plane in 3 (33%) cadavers. Eight (89%) cadavers with HSGs had other associated anomalies: accessory inferior grooves (5), parenchymal nutmeg changes (5), abnormal caudate morphology (4), hyperplastic left hemi-liver (3), lingular process (2), bi-lobar gallbladder (1) and/or abnormal ligamentous attachments (1). Conclusions Approximately 15% of unselected Afro-Caribbean persons in this Eastern Caribbean population have HSGs. Every attempt should be made to identify HSGs on pre-operative imaging because they can alert the hepatobiliary surgeon to: (1) associated anatomic anomalies in 89% of cases, (2) associated hepatic congestion in 56% of persons, (3) increased risk of bleeding during liver resections and (4) increased technical complexity of liver resections. The association between HSGs, cardiovascular complications, hepatic congestion and nutmeg liver prompted us to propose a new aetiologic mechanism for HSG formation, involving localized hyperplasia at growth zones due to upregulation of beta-catenin levels. Keywords Liver · Grooves · Variant · Anatomy · Surface · Surgery
Introduction Hepatic surface grooves (HSGs) are prominent vertical depressions on the antero-superior surface of the liver [5]. Their presence is important to radiologists because they may lead to mis-interpretation of cross-sectional imaging studies [1]. They are also important to trauma surgeons as they may mimic liver lacerations, medical oncologists because they * Shamir O. Cawich [email protected] 1
Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
2
University of the West Indies, Mona Campus, Kingston 7, Jamaica
3
Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
can be mistaken for liver metastases in cancer patients and also to hepatobiliary surgeons since they can be used as anatomic landmarks when planning liver resections [1, 5, 8, 14]. The global prevalence of HSGs range
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