UNASSIGNED: Iatrogenic bile duct injury is a serious complication of laparoscopic cholecystectomy, often due to misinterpretation of biliary tree anatomy. Anatomical variations, patient condition, gallbladder pathology, and surgeon-related factors are key risk factors for bile duct injury.
METHODS: A 68-year-old male with a history of hypertension and type 2 diabetes mellitus underwent Laparoscopic cholecystectomy for symptomatic gallstones. One-month post-surgery, he developed right upper quadrant pain, jaundice, and elevated liver enzymes. Magnetic resonance cholangiopancreatography (MRCP) showed a hilar confluence stricture affecting the right posterior and left hepatic ducts, with mild-to-moderate dilation of upstream intrahepatic bile ducts.
UNASSIGNED: Trifurcation of the hepatic duct is a rare but clinically significant anatomical variation that can predispose patients to common bile duct injuries. Preoperative MRCP can identify such variations, aiding in surgical planning. However, intraoperative recognition and management of these anatomical differences are crucial to prevent bile duct injuries. This is particularly important in low-resource settings where routine preoperative imaging may not be feasible.
CONCLUSIONS: Accurate intraoperative identification of biliary tree anatomical variations is essential to prevent iatrogenic injuries during surgery. Preoperative imaging, when available, can provide valuable information to assist in surgical planning. Additionally, the use of intra-operative cholangiogram (IOC) should be considered to help identify and manage anatomical variations, thereby reducing the risk of bile duct injuries.

UNASSIGNED: During the routine dissection classes for undergraduate medical students, we encountered a rare anatomical variation concerning the aberrant origin and course of the accessory splenic artery. The splenic artery is one of the direct branches of the coeliac trunk. During its tortuous course, it supplies the pancreas with greater curvature of the stomach and spleen. The accessory splenic artery originating from the main trunk of splenic artery, too, follows the same tortuous course while running through the lesser sac and supplies the posterior part of the spleen via the splenophrenic ligament. The accessory splenic artery is gaining clinical importance during various GI surgeries and some radiological procedures. The unnoticed accessory splenic artery damage may result in tremendous bleeding while performing GI-based surgery or radiological investigation like angiography. In our case report, the accessory splenic artery is an aberrant origin from the initial part of the actual splenic artery. Knowledge regarding the origin, course and termination is of utmost importance to GI surgeons, radiologists, and anatomists.

The genitofemoral nerve (GFN) presents with a variable course in nearly half of the population. This variation can be seen in its availability, course, and branching. Here, a notable case during a cadaveric dissection revealed an unusually high bifurcation of the GFN on the left side, contrasting with the typical bifurcation observed on the right. This divergence was highlighted using colored markers to aid educational visualization, facilitating a comprehensive learning experience about the nerve\'s variability and its functional implications, such as the cremasteric reflex. Embryologically, these variations stem from the migratory paths of myotomes during development, influenced by extrinsic signals and growth factors. Despite the high incidence of anatomical variability, the muscular structure remains consistent, suggesting that the nerve\'s formation is more susceptible to developmental shifts than the muscles it innervates. Clinically, understanding GFN variations is crucial due to the nerve\'s involvement in conditions like genitofemoral neuropathy, which can arise from surgical procedures. Accurate knowledge of these variations aids in precise diagnostic and therapeutic interventions, reducing complications, and enhancing patient outcomes in lower abdominal and groin surgeries. However, further research is needed to elucidate the exact embryological and genetic underpinnings of these variations.

OBJECTIVE: A deep knowledge of the variations of the posterior forearm musculature is crucial for assessing and diagnosing conditions in this region. Extensor indicis (EI) is one of the muscles in this region, which exhibits diverse anatomical variations. This report documents an extremely unusual form of the EI with an accessory head on the dorsum of the hand.
METHODS: During routine dissection, an extremely rare presentation of the EI was found in the left forearm of a 94-year-old female cadaver.
RESULTS: This unusual EI consisted of two muscle bellies. The traditional belly originated from the distal two-thirds of the ulna. The muscle became tendinous around the carpal area, distal to the extensor retinaculum. The tendon was subsequently joined by an accessory muscle belly originating from the distal radioulnar ligament. The EI tendon inserted onto the dorsal expansion of the index finger, ulnar to that of the extensor digitorum. The posterior interosseous nerve innervated the muscle.
CONCLUSIONS: Herein, we report an extremely rare form of the EI. To our knowledge, EI with an accessory head has only been reported rarely over the past 200 years. Moreover, our report appears to be the first case with photographic details of this anatomical variation. Clinicians should be aware of this variation for proper diagnosis and treatment.

The maxillary second premolar has long been regarded as a tooth with a straight root canal anatomy, typically featuring a single root with two canals. However, emerging evidence suggests this tooth may harbor a more intricate internal morphology, challenging conventional perceptions, and treatment approaches. One such variation is three root canals within the upper second premolar, which has been gaining increasing attention in endodontic literature. Root canal treatment of maxillary second premolars with three canals demands meticulous debridement, shaping, and disinfection. A combination of magnification, illumination, and appropriate instrumentation aids in locating, negotiating, and cleaning the accessory canals effectively. Thorough cleaning of accessory canals can be achieved through effective irrigation solutions such as sodium hypochlorite, ethylenediaminetetraacetic (EDTA), and chlorhexidine, which help dissolve organic tissues and remove debris. Techniques like ultrasonic and sonic activation, as well as negative pressure irrigation systems, enhance the penetration and effectiveness of these irrigants. Additionally, the use of modern nickel-titanium rotary files, ultrasonic irrigation, and supplementary chelating agents enhances the management of complex canal configurations.

OBJECTIVE: The accessory bones around the elbow are very rare variant structures, present in approximately 0.7% of cases. They can cause diagnostic problems and can be mistaken for pathological structures, especially when pain and limitation of elbow movements are present and a trauma can be traced in the patient\'s history. They are of different nature, either presenting within muscle tendons as sesamoids (brachialis and triceps brachii muscles) or presenting intra-articularly probably as separated or accessory ossification centres. The least common is the os supratrochleare anterius.
METHODS: We present a case of a young male, featuring chronic blocking and 20° limited flexion of his right elbow, which bothered him during his occupation as a locksmith. In history, he suffered minor trauma to the elbow 20 years ago. X-ray and CT showed a large ossicle in the coronoid fossa of the humerus.
RESULTS: The ossicle was surgically extracted in small pieces. The patient left satisfied with no mention of complaints.
CONCLUSIONS: The os supratrochleare anterius is a very rare accessory bone of the elbow, located in the coronoid fossa of the humerus which can mimic many pathological states, and limit movements and causing pain around the elbow.

This paper illustrated successful endodontic non-surgical (re)treatments of molars and premolar with different taurodontic classifications and accompanied anomalies like C-shape and extra root canals in otherwise healthy patients. Magnification with illumination besides active irrigation with NaOCl were the most helpful items in managing these cases.

BACKGROUND: This study aimed to describe the findings of double superior mesenteric veins (SMVs), a rare anatomical variation, on multidetector computer tomography (MDCT) and magnetic resonance imaging (MRI) images.
METHODS: We describe the case of a 34-year-old male, who underwent both MDC and MRI examinations of the upper abdomen because of liver cirrhosis. MDCT and MRI angiography images of the upper abdomen revealed an anatomic variation of the superior mesenteric vein (SMV), the double SMVs.
CONCLUSIONS: The double SMVs are a congenital abnormality without potential clinical manifestation. Physicians need to be aware of this anatomical variation during abdominal surgery to avoid iatrogenic injury.

Agenesis of the left hepatic lobe is a rare anomaly described as the absence of liver tissue on the left side of the gallbladder fossa or falciform ligament. Here we report a case of agenesis of the left hepatic lobe identified during educational dissection of an 84-year-old male formalin-fixed cadaver. The gross anatomical characteristics, embryological origin, and clinical relevance of this rare variation are described in this report.

OBJECTIVE: In the existing literature, various insertion variations and classifications for the Pectoralis Minor (PMi) muscle have been reported. However, there is limited information on inferior origin variations of the PMi muscles and a certain classification is lacking.
METHODS: During routine cadaver dissection of an adult male, variations in the origin of the bilateral PMi muscles were identified. Morphometric measurements of the PMi were conducted using ImageJ software, and the unusual origin patterns of the PMi were categorized into specific types. The PMi muscle demonstrated a bilateral variations. On the right side, the PMi displays a bifid structure comprising medial and lateral fibers. The left PMi originate from the superolateral margins of the 4th to 6th costae and terminate at the anterosuperior surface of the coracoid process. The length of the right medial fiber before merging was 5.67 ± 0.04 cm, while that of the right lateral fiber was 6.68 ± 0.05 cm. The distance between the two fibers was measured as 0.43 cm, with a length of 3.33 ± 0.02 cm. The length and diameter of the muscle fibers extending to the 6th costa were 2.63 ± 0.01 cm and 0.46 cm, respectively.
CONCLUSIONS: Potential variations in PMi arising from impairment during development may occasionally manifest as asymptomatic conditions or predispose individuals to shoulder impingement, rotator cuff dysfunction, shoulder-related disorders, and functional impairments. Therefore, careful attention to this variation is considered in surgical planning.