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The anatomy of the liver of the human fetus was established on the basis of cadaveric techniques, but its study has been transformed by obstetric ultrasonography. This work is based on a personal study of the normal morphology of the liver of the human fetus and on a review of the current literature, particularly with regards to vascularization. The liver is the digestive organ whose rudiments appear earliest and which develops most rapidly. The development of the liver and its functional segmentation are determined by the oxygenated blood flow in the umbilical vein. The extent of each hepatic territory depends on the quantity of umbilical flow, which determines its development and ensures its function. The fetal liver occupies a very large proportion of the abdominal cavity. It is a vascular organ, closely moulded to the walls of the abdominal cavity and the viscera in contact with it. The left liver is a little more bulky than the right liver and is developed mainly transversely. The morphology of the normal fetal liver appears quite uniform. The intrahepatic umbilical vein and the venous axis prolonging it to the right have a remarkably constant arrangement, well demonstrated by ultrasonography. An assessment of the anatomic features of the afferent veins, the ductus venosus and the efferent veins gives some idea of the conditions of the intrahepatic venous circulation in the human fetus that remain to be demonstrated. At birth, ligature of the umbilical v. brings about a sudden change in the hepatic circulation, resulting in temporary morphologic and functional modifications in the liver.(ABSTRACT TRUNCATED AT 250 WORDS)

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In general, frontal sections of the liver in magnetic resonance imaging are used less than sections passing through other planes of space. Frontal sections of the trunk in magnetic resonance imaging involving the liver, performed in over 80 patients for various reasons, were compared with frontal sections of the trunk made in 10 cadavers. A general schema was established of the anatomy of the liver studied in the frontal plane. Frontal sections in magnetic resonance imaging make it possible to form a very good estimate of the structure and size of the liver, and to recognize individual variations. They clearly show certain inferior relations of the liver. In particular, frontal sections in magnetic resonance imaging make it possible to identify most of the main veins of the liver, the main lobar veins and branches of the portal vein, and to properly study the entire retrohepatic portion of the inferior vena cava. Some of the vascular images were found almost constantly in the sections of the various subjects. The right lobe of the liver is more accessible to such study than the left by reason of its structure and its venous arrangements. Frontal sections of the liver in magnetic resonance imaging constitute a preferential method for studying the anatomy of the liver. Together with transverse sections, they make it possible to specify the site and venous relations of a pathologic process within the liver, with a view to hepatectomy.

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Anomalies of hepatic morphology, as opposed to anatomical variations, are rare. Nevertheless, knowledge of such anomalies is important since they do not always remain clinically latent. Four case studies of different types of anomalies encountered in surgical practice in the adult are reported herein. A general review of hepatic anomalies can be divided into two categories, i.e. anomalies due to defective development and anomalies due to excessive development of the liver. Such disturbances are sometimes associated with malformations of other structures, especially the diaphragm and suspensory apparatus of the liver. Defective development of the left lobe of the liver can lead to gastric volvulus. Conservely, defective development of the right lobe either remains clinically latent or leads to portal hypertension. Anomalies related to excessive development of the liver lead to formation of accessory lobes annexed to the liver. Despite their diversity of shape, size and location, such accessory lobes have common features allowing them to be considered as an entity. In most cases the accessory lobe is found in the infra-hepatic position. Riedel's lobe is the best known example of a sessile accessory lobe. Accessory lobes may also stimulate tumor. In cases where the accessory lobe has a pedicle, torsion is a common event leading to discovery of the abnormal mass. The origin of the anomalies of hepatic morphology occurring in the course of organogenesis remains to be elucidated. The use of ultrasonography should now allow identification of such anomalies prior to the occurrence of an acute complication and in the future to possibly detect them in the fetus.

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Thirty six hepatobiliary scintigraphies with 99mTc-Dimethyl IDA were performed in thirty patients with an hepaticojejunostomy one month to ten years after surgery. Twenty patients underwent surgery for biliary disease and ten for duodenal or pancreatic disease. In most cases (twenty three), the radionuclide study has been systematically performed to assess the scintigraphic pattern of a normal hepaticojejunostomy. In seven cases this pattern was abnormal. Four times the biliary enteric anastomosis was involved. Three times it showed an abnormal liver morphology. After an hepaticojejunostomy, hepatobiliary scintigraphy seems to be the only examination providing dynamic information for the biliary enteric anastomosis and the intestinal loop. But it sometimes is difficult to analyse in all cases, it must be the screening test in patients when symptoms occur after hepaticojejunostomy; but a percutaneous transhepatic cholangiogram cannot always be avoided.

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A cysticohepatic duct drains a particular region of the liver. It represents an anatomical variation of the biliary tree. On the contrary, a subvesicular duct represents an abnormality of the biliary ducts development. It belongs to aberrant biliary ducts (vasa aberrantia) and has all their morphologic characteristics.

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A procedure of total vaginal hysterectomy without vaginectomy with a vaginal vault suspension to the anterior abdominal wall-- without laparotomy--is presented. The patient for whom this operation is indicated is the old sexually active women.

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The usual radiographic projections do not enable to do a complete diagnosis of the pattern of the calcanear fractures. Horizontal tomograms, performed since 1975 by the authors with a complex movement tomographe show the superior surface of the calcaneus. Compared with the sagittal and frontal tomograms, they are absolutely necessary to know the shape of the fractured calcaneus and to precise the anatomical basis of its treatment.

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