Multiple anatomical variations of the hepatic pedicle: case report and clinical application / Múltiples variaciones anatómicas del pedículo hepático: reporte de caso y aplicación clínica

The knowledge in detail of the anatomy of the hepatic pedicle is critical when operating it and its surroundings. The presence of anatomic variations is higher at the arterial component level than at the bile component level or venous component level, which in the 90% of the cases it appears as the classic description. The presented case in this work implies a very low frequency of appearance. For this reason, the surgeon must be alert at the moment of making a decision so as to avoid injuries that may put the patient´s life at risk.

El conocimiento en detalle de la anatomía del pedículo hepático es fundamental al momento de intervenir quirúrgicamente sobre el mismo y su vecindad. La presencia de variaciones anatómicas es mayor a nivel del componente arterial, luego biliar y finalmente venoso, el cual en el 90% de los casos se dispone de acuerdo con la descripción clásica. El caso presentado en este trabajo supone una muy baja frecuencia de aparición, siendo precisamente estas disposiciones poco habituales las que obligan al cirujano a mantenerse alerta en el momento de actuar para evitar injurias que puedan comprometer la vida del paciente.

Aspectos morfológicos, morfométricos e ultraestruturais do baço de ratos após o clampeamento total do pedículo hepático / Morphologic, morphometric, and ultrastructural aspects of the spleen of rats after hepatic pedicle total clamping

Avaliaram-se as alterações morfológicas, morfométricas e ultraestruturais que ocorreram no baço devido à isquemia produzida pelo clampeamento total do pedículo hepático. Para tanto, foram utilizados 40 ratos machos, distribuídos em quatro grupos de 10 animais. O grupo-controle (C) não foi submetido à isquemia, e os grupos tratados (E1, E2e E3) foram submetidos ao clampeamento por 10, 20 e 30 minutos, respectivamente. Fragmentos do baço foram retirados e analisados histologicamente pela microscopia de luz (hematoxilina-eosina, ferrocianeto-férrico) e pela microscopia eletrônica de transmissão. Os resultados demonstraram que 10 minutos de clampeamento do pedículo hepático são suficientes para apresentar sinais de congestão esplênica e 20 e 30 minutos promovem intensa digestão de hemácias pelos macrófagos, com presença de grânulos de ferro (hemossiderina) no parênquima esplênico.

The macro and microscopic alterations that occurred in the spleen during an ischemia produced by the hepatic pedicle total clamping were studied. Forty male rats were distributed in four groups of 10 animals each. The control group (C) was not submitted to ischemia and the treated groups (E1, E2, and E3) were submitted to the clamping during 10, 20, and 30 minutes, respectively. Spleen fragments were collected and histologically analyzed by the light microscopy (eosin-hematoxilin and ferric ferrocyanide) and by the transmission electron microscopy. The results showed that 10 minutes of hepatic pedicle total clamping was enough produce signs of splenic congestion and 20 and 30 minutes promoted intense red bood cels digestion by the macrophages with the presence of iron granules (hemosiderin) in the splenic parenchyma.