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Human liver umbilical fissure variants: pons hepatis (ligamentum teres tunnel)

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Abstract

Purpose

In the classical description of normal liver anatomy, the umbilical fissure is a long, narrow groove that receives the ligamentum teres hepatis. The pons hepatis is an anatomic variant, where the umbilical fissure is converted into a tunnel by an overlying bridge of liver parenchyma. We carried out a study to evaluate the existing variations of the umbilical fissure in a Caribbean population.

Methods

We observed all consecutive autopsies performed at a facility in Jamaica and selected cadavers with a pons hepatis for detailed study. A pons hepatis was considered present when the umbilical fissure was covered by hepatic parenchyma. We recognized two variants: an open-type (incomplete) pons hepatis in which the umbilical fissure was incompletely covered by parenchyma ≤ 2 cm in length and a closed type (complete) pons hepatis in which the umbilical fissure was covered by a parenchymal bridge > 2 cm and thus converted into a tunnel. We measured the length (distance from transverse fissure to anterior margin of the parenchymatous bridge), width (extension across the umbilical fissure in a coronal plane) and thickness (distance from the visceral surface to the hepatic surface measured at the mid-point of the parenchymal bridge in a sagittal plane) of each pons hepatis. A systematic literature review was also performed to retrieve data from relevant studies. The raw data from these retrieved studies was used to calculate the global point prevalence of pons hepatis and compared the prevalence in our population.

Results

Of 66 autopsies observed, a pons hepatis was present in 27 (40.9%) cadavers. There were 15 complete variants, with a mean length of 34.66 mm, mean width of 16.98 mm and mean thickness of 10.98 mm. There were 12 incomplete variants, with a mean length of 17.02 mm, width of 17.03 mm and thickness of 9.56 mm. The global point prevalence of the pons hepatis (190/5515) was calculated to be or 3.45% of the global population.

Conclusions

We have proposed a classification of the pons hepatis that is reproducible and clinically relevant. This allowed us to identify a high prevalence of pons hepatis (41%) in this Afro-Caribbean population that is significantly greater than the global prevalence (3.45%; P < 0.0001).

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Data availability

All data will be made available to the editorial board upon request.

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Acknowledgements

The authors confirm that there are no financial or other limitations that serve as a conflict of interest in this research. There were no financial support or research grants made available to support this research. The authors wish to thank Peter Ho and Amanda Chow for assisting with the illustrations, dissections and photography used in this manuscript

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No funding or research grants were made available to facilitate this research.

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Authors and Affiliations

  1. Port of Spain General Hospital, Port of Spain, Trinidad and Tobago

    Shamir O. Cawich & Vijay Naraynsingh

  2. Section of Anatomy, University of the West Indies, Mona Campus, Kingston 7, Jamaica

    Michael T. Gardner & Ramnanand Shetty

  3. Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK

    Neil W. Pearce & Thomas Armstrong

  4. Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK

    Rahul Deshpande

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  1. Shamir O. Cawich
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Contributions

SOC: protocol development, data management, data analysis, manuscript writing. MTG: data analysis, manuscript editing, protocol development. RS: data collection, data analysis, manuscript editing. NWP: data collection, data analysis, manuscript editing. RD: data collection, data analysis, manuscript editing. VN: data analysis, manuscript editing, protocol development. TA: data analysis, manuscript editing, protocol development.

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Correspondence to Shamir O. Cawich.

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Cawich, S.O., Gardner, M.T., Shetty, R. et al. Human liver umbilical fissure variants: pons hepatis (ligamentum teres tunnel). Surg Radiol Anat 43, 795–803 (2021). https://doi.org/10.1007/s00276-021-02688-8

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