Dangerous course and atypical termination of the splenic vein in relation to pancreas--a case report.

CONTEXT: Knowledge of variations of the vessels closely related to the pancreas adds greatly to the success of pancreatic surgery. Splenic vein is one of the vessels that are closely related to the pancreas. Its variations might not only change the haemodynamics in the vein but also cause unexpected bleeding during pancreatic surgery. CASE REPORT: During our dissection classes, we noted the variations in the course and termination of the splenic vein. After emerging from the spleen, it coursed upward and to the right, embedded in a groove on the anterior surface of body of pancreas. After reaching the upper border, it turned downwards and entered the body of the pancreas. After having a downward course in the body of pancreas, it emerged out and united with the superior mesenteric vein at an angle of about 160 degrees to form the portal vein. CONCLUSION: This peculiar course of the vein might predispose it for thrombosis in case of pancreatitis. It can also lead to iatrogenic injuries during pancreatic or splenic surgeries.

Duplicated right crus of the diaphragm: a cadaveric case report.

The lumbar part of the diaphragm arises from the lumbar vertebrae by right and left crura. The duplication of crura of the diaphragm is rarely reported in the past. During regular dissection classes to the medical students, we came across a case of duplicated right crus of the diaphragm. The right crus of the diaphragm was duplicated completely and presented two separate crura; medial right crus & lateral right crus. The medial right crus was attached to the anterolateral surfaces of the superior three lumbar vertebral bodies and intervertebral discs and merged with the anterior longitudinal ligament. The lateral right crus attached only to the intervertebral disc between the third and fourth lumbar vertebrae. These two crura bordered a retrocrural space in the inferior posterior mediastinum. The greater and lesser splanchnic nerves entered the abdomen by passing through this space. No duplication was observed in the left crus. The muscle fibres of medial right crus contributed to the formation of the esophageal opening. Knowledge of variations in the diaphragmatic crural anatomy is useful in the diagnosis of disease processes in the retrocrural space and also might help while performing the surgical repair of gastroesophageal reflux disease.

La partie lombaire du diaphragme se divise en pilier droit et pilier gauche qui s'attachent directement aux vertèbres lombaires. La duplication des piliers du diaphragme est rarement signalée dans le passé. Pendant les cours réguliers de dissection avec les étudiants en médecine, nous avons constaté un cas de duplication du pilier droit du diaphragme. Le pilier droit du diaphragme a été dupliqué complètement et se présentait comme deux piliers distincts : pilier médial droit et pilier latéral droit. Le pilier médial droit était toujours attaché aux surfaces antérolatérales des trois corps vertébraux lombaires supérieures et aux disques intervertébraux, et se confondait avec le ligament longitudinal antérieur. Le pilier latéral droit était attaché seulement au disque intervertébral entre la troisième et la quatrième vertèbre lombaire. Ces deux piliers étaient accolés à un espace inframédiastinal dans le médiastin postérieur inférieur. Les nerfs splanchniques (grands et petits) entraient dans le ventre en passant par cet espace. Aucune duplication du pilier gauche n'a été observée. Les fibres musculaires du pilier médial droit ont contribué à la formation de l'ouverture de l'œsophage. La connaissance des variations de l'anatomie du diaphragme crural est utile pour le diagnostic des processus pathologiques dans l'espace inframédiastinal et peut aussi être utile lors d'une réparation chirurgicale du reflux gastro-œsophagien pathologique.