A Rare Case of Undescended Caecum Accompanied by Looped Retroperitoneal Appendix

Intestinal malrotations are associated with various anatomical anomalies. We report a unique case wherein the caecum was located in the right lumbar region instead of the right iliac fossa. The ileo-caecal junction was also placed higher up. The appendix was ‘uncinate’ shaped, highly coiled and retroperitoneal with the absence of mesoappendix. Both, the caecum and appendix were supplied by ascending branch of the ileocolic artery instead of the descending branch. Further, we also observed that the ascending colon was very short and sub-hepatic in position. Such type of variations is of clinical and surgical importance in diagnosis and treatment of appendicitis.

Uncommon Peritoneal Anomaly of Spleen Associated with the Unusual Relationship of Spleen with the Left Lobe of the Liver

Though congenital anomalies of the spleen are quite common, the peritoneal anomalies of the spleen are very rare. In the present case, we observed two unusual phrenico-splenic ligaments connecting the spleen to the diaphragm. Apart from this, the left lobe of the liver was elongated and was related to the diaphragmatic surface of the spleen. The splenic artery had a straight course to the spleen, indicating the possible restricted movements of the spleen. Knowledge of such unusual relation of spleen is essentially important for the surgeons as the elongated left lobe of the liver might get ruptured in addition to the spleen in the fractures of the left 9th, 10th and 11th ribs. Awareness of the straight course of the splenic artery is also of importance to Radiologists performing arterial splenoportography.

Replaced Right Hepatic Artery Associated with Uncommon Triplet Right Renal Vein: Embryological Perspective and Clinical Importance 45

Vascular variations in the abdomen are common and mostly asymptomatic. Knowledge of these variations are of tremendous clinical importance in patients undergoing invasive endovascular interventions such as liver transplantation, renal transplantation, and vascular reconstruction for congenital and acquired lesions and trans-arterial chemoembolization for the hepatic tumors. During regular dissection classes for the medical undergraduates, we encountered concurrent vascular variations in an elderly male cadaver. In the present case, we report multiple vascular anomalies involving the right hepatic artery and the right renal vein. The right hepatic artery branched off from superior mesenteric artery, and it was identified as a replaced right hepatic artery. The right kidney was drained by three renal veins, the uppermost among the three twisted around the superior branch of the right renal artery before terminating into the inferior vena cava. In addition, the left kidney was supplied by two renal arteries, and drained by a single renal vein.