RESUMO
INTRODUCTION: Anomalies and diseases of the biliary system are common with over 20 million cases of biliary disease and an estimated 1.8 million ambulatory visits each year in the United States. Congenital anomalies of the gallbladder are rare and include complete and partial duplications, floating gallbladders, and agenesis. Septations have also been reported in the literature. Case reports have typically described these as longitudinal. Transverse septa, when reported, are associated with inflammation or cholelithiasis. Variations in the cystic duct and vasculature in the portal triad have also been well described. PRESENTATION OF CASE: During the dissection of a 91-year-old female cadaver, an enlarged gallbladder with a partial transverse septum was observed. The gallbladder contained approximately 350 ml of bile, no stones, and had a partial transverse septum near the infundibulum. The hepatic, cystic, and common bile ducts were enlarged, but of normal configuration. Vascular anomalies were also present, including an accessory left hepatic artery from the left gastric artery and an anomalous origin of the right hepatic artery from the superior mesenteric artery. DISCUSSION: This is the first described case of a partial transverse septum with a markedly enlarged gallbladder, dilated duct system, and vascular anomalies in a patient with no evidence of gallstones, inflammation, or scarring. CONCLUSION: With the prevalence of biliary disease and frequent subsequent surgery it is essential to appreciate all anatomical variations to avoid iatrogenic injuries to these structures during surgery.
RESUMO
INTRODUCTION: During an anatomical dissection of the distal upper extremities, numerous muscular and nervous anomalies were found in the forearm and hand of a 94-year-old cadaver. These anomalies are clinically relevant with regard to medical or surgical interventions. PRESENTATION OF CASE: The presence of a "flexor digiti minimi longus" muscle was observed passing through Guyon's canal; to our knowledge this passageway has never been previously reported. An aberrant first lumbrical with three origins was noted. Additionally, numerous atypical nerves were found innervating the hand; the dorsal branch of the ulnar nerve contributed to cutaneous innervation of the palm of the hand (Kaplan's anastomosis), the superficial ulnar nerve provided muscular innervation to the flexor digiti minimi brevis muscle, and two connections between the common palmar digital branches of the median and superficial ulnar nerves were observed (Berrettini anastomosis). DISCUSSION: Here, we describe an extranumerary muscle associated with the hypothenar group of muscles. We also describe unusual origins of the first lumbrical muscle, and atypical cutaneous and muscular innervation to the palm of the hand. CONCLUSION: Clinically, understanding the existence of these anatomical variations may influence medical care or surgical procedures.
