The importance of variant insertions of the ligamentum teres hepatis in the Cruveilhier-Baumgarten syndrome.

Within the framework of a prospective study, we were able to establish that in 50 per cent of 220 patients submitted to laparoscopy, the ligamentum teres hepatis did not run from the porta hepatis directly to the umbilicus, but to a point of insertion craniad to the umbilicus in the median line of the anterior abdominal wall. As a rule, this topographic variant has no clinical relevance. It is, however, of importance in patients with cirrhosis of the liver and portocaval collateral channels. In our group, 25 per cent of the patients revealed complete cirrhotic transformation of the liver; in a quarter of these, the Cruveilhier-Baumgarten syndrome presented, and thus also the possibility that large-caliber porto-femoral "umbilical" vessels might be running a course to the left of the umbilicus. The danger of injuring such a vessel during laparoscopy can, however, be prevented: in seven out of eight patients with portofemoral collaterals, this situation was established by ultrasonic examination, and in three cases, the periumbilical course of these vessels was accurately determined prior to carrying out the procedure. In our opinion, the definition of the Cruveilhier-Baumgarten syndrome needs to be extended. The results of our investigation show that, within the framework of portal neo-vascularisation, direct umbilical vein recanalisation is a relatively rare occurrence (approximately 15 per cent), while porto-femoral collateral formation is considerably more common (about 70 per cent).