Aberrant pancreatic ductal organisation: a case report.

Anomalous pancreatic ductal system has always enthralled the anatomists, surgeons, gastroenterologists and radiologists alike. With the growing use of MRCP, ERCP and endoscopic and surgical procedures, the knowledge of anatomical aberrations of pancreaticobiliary tract becomes extremely important. Moreover, the anomalous pancreatic duct morphology may be responsible for atypical gastrointestinal complains. We report an exceptionally rare case of two accessory ventral pancreatic ducts opening separately into the common bile duct proximal to the hepato pancreatic ampulla. Concomitant occurrence of an ectopic major duodenal papilla, 3.8 cm distal to the pyloric end of stomach was also seen. Moreover, the accessory pancreatic duct and the minor duodenal papilla were absent. Clinical implications and embryological description of these rare anomalies are discussed. Awareness of such rare morphological variants can go a long way in assisting effective patient management.

The Anterolateral Ligament of the Knee: Descriptive Anatomy and Clinical Correlation.

BACKGROUND: The anterolateral ligament is a fibrous structure in the anterolateral aspect of the knee. Recently this liagament of the knee has gained spotlight in anatomical and imaging studies and has been designated as a new ligament of the knee joint. The anterolateral ligament (ALL) has been postulated to be a restraint against the anterolateral instability of the knee resulting in a positive pivot shift test. The purpose of this study is to provide detailed anatomical characteristics of ALL in the Indian population. MATERIALS AND METHODS: The qualitative and quantitative characteristics of the ALL were observed in 20 embalmed cadaveric specimens. In all but one left male knee specimen (95%) ALL was observed. After isolating the ALL, its length, thickness, width, and points of attachments and dimensions of lateral collateral ligament (LCL) were determined. RESULTS: The ALL was consistently present in the anterolateral region of the knee separate from the joint capsule. Its proximal attachment to the femur is anterior and distal to the attachment of the LCL. Distally the superficial fibers of the ALL inserted close to the Gerdy's tubercle at the level of the fibular head, and the deeper fibers merged with the lateral meniscus. The mean length of the ALL was 43.35 mm ± 4.04 mm in flexion and 40.38 mm ± 4.35 mm in extension. The average width of the ALL was 6.98 mm ± 0.95 mm at its origin and 9.36 mm ± 1.07 mm at its insertion. CONCLUSION: The ALL is hypothesized to affect internal tibial rotation and plays a role in the pivot shift phenomenon. ALL rupture could be responsible for rotatory laxity after isolated intraarticular reconstruction of the ACL.

Peripheral communications of intercostobrachial nerve Peripheral communications of the intercostobrachial nerve in relation to the alar thoracic artery.

The intercostobrachial nerve (ICBN) is often encountered during axillary dissection for axillary lymph node dissection (ALND) for diagnostic and therapeutic surgery for mastectomy. The present report is a case observed in the Department of Anatomy at Vardhman Mahavir Medical College, Delhi during routine dissection of the upper extremity of a male cadaver for first year undergraduate medical students. On the right side, the medial cord of brachial plexus gave two medial cutaneous nerves of arm. Both the nerves were seen communicating with the branches of the ICBN. The ICBN and one of its branches were surrounding the termination of an alar thoracic artery. These peripheral neural connections of the ICBN with the branches of the medial cord can be a cause of sensory impairment during axillary procedures done for mastectomy or exploration of long thoracic nerves. The alar thoracic artery found in relation to the ICBN could further be a cause of vascular complications during such procedures.

Multiple unilateral variations in medial and lateral cords of brachial plexus and their branches.

During routine dissection of the upper extremity of an adult male cadaver, multiple variations in branches of medial and lateral cords of brachial plexus were encountered. Three unique findings were observed. First, intercordal neural communications between the lateral and medial cords were observed. Second, two lateral pectoral nerves and one medial pectoral nerve were seen to arise from the lateral and medial cord respectively. The musculocutaneous nerve did not pierce the coracobrachialis. Finally, the ulnar nerve arose by two roots from the medial cord. Knowledge of such variations is of interest to anatomists, radiologists, neurologists, anesthesiologists, and surgeons. The aim of our study is to provide additional information about abnormal brachial plexus and its clinical implications.