Reconfirmation of the anatomy of the left triangular ligament and the appendix fibrosa hepatis in human livers, and its implication in abdominal surgery

Kogure, Kimitaka; Kojima, Itaru; Kuwano, Hiroyuki; Matsuzaki, Toshiyuki; Yorifuji, Hiroshi; Takata, Kuniaki; Makuuchi, Masatoshi

doi:10.1002/jhbp.144

Cited by 9 publications

(9 citation statements)

References 16 publications

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“…The free edge of the hepatic LTL is developed by between 3 weeks and 2 years of age. AFH is not found during this period, but it was reported in a 4-year-old patient [10]. Champetier et al [12] reported several cases of spontaneous biliary peritonitis that was caused by the rupture of an aberrant bile duct in the free edge of the LTL.…”

Section: Discussionmentioning

confidence: 81%

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Biliary Peritonitis Caused by Spontaneous Bile Duct Rupture in the Left Triangular Ligament of the Liver after Endoscopic Sphincterotomy for Choledocholithiasis

Fukui¹,

Chochi²,

Maeda³

et al. 2021

Case Rep Gastroenterol

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Spontaneous bile duct rupture is a rare condition in adults, with only 70 cases reported. Increased bile duct wall pressure may lead to rupture and biliary peritonitis. In this patient, the bile duct ruptured in the hepatic left triangular ligament. A 91-year-old man underwent endoscopic retrograde cholangiopancreatography for choledocholithiasis and endoscopic retrograde biliary drainage (ERBD) placement. One week later, removal of the ERBD and common bile duct stones and an endoscopic sphincterotomy (EST) were performed. Four days later, the patient had abdominal pain, increased inflammatory reaction, and jaundice. Abdominal computed tomography showed ascites, bile duct dilatation and fluid collection under the liver (10 cm in diameter). Emergency surgery was performed to drain the fluid. On laparotomy, encapsulated biliary ascites was seen. To search for the site of the leak, after cholecystectomy, a tube (C-tube) was inserted into the common bile duct via cystic duct stump. Because of uncontrollable bleeding, after packing with surgical gauze, the operation was temporarily stopped. The next day, reoperation was performed. Intraoperative cholangiography with contrast dye revealed the perforation site in the left triangular ligament and a partial resection was performed. Bile excretion from the C-tube was subsequently observed, but the patient’s jaundice did not improve. Although endoscopic retrograde cholangiopancreatography revealed that the EST site was normal, ERBD was placed again, and the jaundice gradually improved. Although EST was performed in this case, biliary peritonitis resulting from spontaneous bile duct rupture occurred. This case was very informative because biliary perforation may occur even after EST.

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Section: Discussionmentioning

confidence: 81%

“…The LTL has a long free edge that extends from the lateral extremity of the left liver lobe to the diaphragm. Ferrein was first to describe aberrant bile ducts in the free edge, and he also called them appendix fibrosa hepatis (AFH) [10]. AFH was found in 89% of Chinese and 80% of Canadian patients in the proximal one-third of the LTL.…”

Section: Discussionmentioning

confidence: 99%

Biliary Peritonitis Caused by Spontaneous Bile Duct Rupture in the Left Triangular Ligament of the Liver after Endoscopic Sphincterotomy for Choledocholithiasis

Fukui¹,

Chochi²,

Maeda³

et al. 2021

Case Rep Gastroenterol

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“…The other condition can be a fibrous appendix of the liver which is a fibrous connective-tissue (atrophied hepatic tissue) process that extends from the lateral end of the left lobe of the liver and passes with the left triangular ligament to get attached to the diaphragm [ 8 ]. It may have various shapes but regardless contain liver parenchyma along with the blood vessels (like a hepatic artery, portal vein, hepatic vein) and bile ducts [ 8 ], thus it is an important structure and ligation should be done with care [ 8 ]. Rarely the liver tissue in the left triangular ligament can show hepatic pathologies.…”

Section: Discussionmentioning

confidence: 99%

Beaver Tail Liver: A Hepatic Morphology Variant

Khanduri

Malik

Khan

et al. 2021

Cureus

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Beaver tail liver, or else known as the sliver of liver, is a rare anatomic variation of the liver where the left lobe of the liver extends laterally to contact and enwrap the spleen.A case is presented here where a middle-aged male presented with complaints of abdominal pain, hematuria, and fever. After the routine blood and urine examinations revealed urinary tract infection, CT abdomen was done to find out the etiology, and beaver tail liver was found incidentally with the left lobe of liver encircling the spleen.Sometimes it may be difficult to differentiate liver and spleen from each other when echogenicity or density on USG and CT are equivalent. More common in females, it may imitate a splenic trauma or a subcapsular hematoma, or a perisplenic hemorrhage within the splenic parenchyma.

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“…There appear to be two common interpretations of a beaver tail liver. One refers to the appendix fibrosa hepatis (to which the left triangular ligament attaches). This is a fibrous band which attaches to the diaphragm at the left extremity of the liver and may contain liver parenchyma .…”

mentioning

confidence: 99%

“…This is a fibrous band which attaches to the diaphragm at the left extremity of the liver and may contain liver parenchyma . This is an important structure intraoperatively as it may contain blood vessels and bile ducts and should be ligated with care . In a cadaveric study, for example, ‘comparatively large bile ducts’ were found in 12 of 27 examined specimens of the left triangular ligament …”

mentioning

confidence: 99%

Beaver tail liver: Anatomic variant

et al. 2018

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Reconfirmation of the anatomy of the left triangular ligament and the appendix fibrosa hepatis in human livers, and its implication in abdominal surgery

Abstract: As AFH sometimes includes relatively large bile ducts, it is recommended for surgeons to sever the AFH not just simply by electrocautery but by ligating its stump securely.

Cited by 9 publications

References 16 publications

Biliary Peritonitis Caused by Spontaneous Bile Duct Rupture in the Left Triangular Ligament of the Liver after Endoscopic Sphincterotomy for Choledocholithiasis

Biliary Peritonitis Caused by Spontaneous Bile Duct Rupture in the Left Triangular Ligament of the Liver after Endoscopic Sphincterotomy for Choledocholithiasis

Beaver Tail Liver: A Hepatic Morphology Variant

Beaver tail liver: Anatomic variant

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