Abdomen
David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings in McMinn’s Concise Human Anatomy, 2017
not found on the caecum, where they form a complete sheet of muscle.The greater omentum attaches cranially to the greater curvature of the stomach lying anterior to all of the small intestine. It is mobile and is often referred to as the ‘policeman of the abdomen’, as it tends to wrap around areas of inflammation within the peritoneal cavity.Meckel’s diverticulum is normally present and is located 60 cm proximal to the ileocaecal valve in the left iliac fossa.The porta hepatis is located to the left of mid-line and marks the position where the greater omentum joins the lesser curvature of the stomach to the visceral surface of the liver.
Abdomen
Harold Ellis, Adrian Kendal Dixon, Bari M. Logan, David J. Bowden in Human Sectional Anatomy, 2017
This section passes through the body of the twelfth thoracic vertebra (15). It demonstrates well the relationships of the structures at the porta hepatis – the common bile duct (33) anterior and to the right, the hepatic artery (32) anterior and to the left, and the portal vein (31) posterior to these structures. The inferior vena cava (29) lies immediately behind the portal vein; between the two is the epiploic foramen, or the aditus to the lesser sac (the foramen of Winslow). The division between the cortex (peripheral) and medulla (central) of the kidneys (16, 17) is shown well; in the plane of this division run the small arcuate vessels, which can just be identified in this section. Post-mortem changes account for the discrepancy in the differentiation between cortex and medulla in the left kidney.
Biliary Atresia
Gianfranco Alpini, Domenico Alvaro, Marco Marzioni, Gene LeSage, Nicholas LaRusso in The Pathophysiology of Biliary Epithelia, 2020
The size of prehilar bile duct structures with lumens having diameters greater than 150 μm,53 or 400 μm,54 has been considered a favorable prognostic indicator. Other indicators such as Caucasian race, presence of severe biliary cholangiopathy, and presence of cirrhosis have been considered poor prognostic indicators.55–60 In one study the absence of ductal remnants at the porta hepatis and the absence of portal inflammation were associated with worse prognosis as though there has been a “burnout” as the end result of the disease process.60 In one very interesting study, Nietgen compared the livers of several patients with BA from the time of diagnosis of BA to the time of the Kasai procedure and then to the time of liver transplantation and found that there was a progressive loss of intrahepatic bile ducts.61 Although the authors attributed this to a combination of progression of the disease with partial unrelieved obstruction and uneven obstruction due to portoenterostomy wound healing and scarring, they could not exclude the possibility that the initial needle and wedge biopsies gave a partial sampling error and that the natural history of this disease results in intrahepatic bile duct loss in the subgroup of infants which does not respond to portoenterostomy.
Surgical approaches for the treatment of perihilar cholangiocarcinoma
Published in Expert Review of Anticancer Therapy, 2018
Charles W. Kimbrough, Jordan M. Cloyd, Timothy M. Pawlik
The principal difference in performing liver resections for pCCA is management of the biliary tree. This typically requires extrahepatic dissection of the porta hepatis to ensure resectability, followed by intrahepatic bile duct resection with parenychmal transection. Division of the biliary tree varies by the location of the tumor and planned extent of hepatic resection (Figure 2). For right hepatectomy, the proximal left duct is transected to the right of the umbilical portion of the left portal vein. Division occurs to the left of the umbilical portion of the left portal vein for a right trisectionectomy that includes segment 4. For left hepatectomy or left trisectionectomy, the right duct is divided either at the level of the right portal pedicle or right posterior sectoral pedicle, respectively (Figure 3). To restore drainage, an enteric-biliary anastomosis is necessary.
Efficacy and safety of CT-guided percutaneous thermal ablation for hepatocellular carcinoma adjacent to the second porta hepatis
Published in International Journal of Hyperthermia, 2019
Lin Xie, Fei Cao, Han Qi, Ze Song, Lujun Shen, Shuanggang Chen, Yubin Hu, Chao Chen, Weijun Fan
Treatment for patients with tumors adjacent to the second porta hepatis was difficult. Traditional surgery involved the disadvantages of high morbidity and operation trauma. Recently, thermal ablation served with promising effect as a minimally invasive treatment for liver tumors. Several studies have reported it to be an effective alternative treatment for perivascular hepatic tumors. Kang et al. reported that the outcomes of RFA for small perivascular HCC were similar to those for nonperivascular HCC [20]. However, the notable heat-sink effects that influenced our outcomes were also reported in previous studies [14–16]. Due to concerns of limited efficacy and severe complications, the location of tumors near the second porta hepatis used to be regarded as a contraindication for ablation; until now, no research has been reported in this area. Results of the present study show that thermal ablation is a safe and feasible treatment for tumors adjacent to second porta hepatis.
Primary anaplastic large cell lymphomas of the pancreas
Published in Baylor University Medical Center Proceedings, 2022
Ling Chen, John R. Krause, Haiying Zhang
A 66-year-old woman presented with abdominal pain and jaundice. Computed tomography revealed a locally invasive 5.0 × 3.9 cm mass in the porta hepatis/pancreatic head. There was no peripheral adenopathy and no involvement of liver or spleen. Subsequent magnetic resonance imaging showed the mass contiguous with the largest conglomerate of lymph nodes in the porta hepatis region. The imaging findings raised broad differentials, including primary pancreatic carcinoma, primary pancreatic lymphoma, extrahepatic cholangiocarcinoma, and metastasis. Fine needle aspiration of the pancreatic mass (Figure 2a, 2b) revealed large-sized malignant cells with abundant cytoplasm and pleomorphic, eccentric nuclei. Immunohistochemically, the tumor cells were positive for CD30 (Figure 2c) and CD4, patchy positive for CD3, and negative for CD20 and ALK (Figure 2d). The malignant cells were also negative for CK-CAM 5.2, CK19, SOX10, synaptophysin, chromogranin, as well as for mucicarmine stain and EBER. The Ki-67 proliferative index was nearly 90% in malignant cells. Diagnosis of ALK-negative ALCL was made. The patient was scheduled to receive chemotherapy at another institution.
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