Hepatic flexure in right sub diaphragmatic space and its embryological basis and clinical importance

The knowledge of variations in the large intestine and liver is of clinical importance from the anatomical and embryological points of view. Different positions of the hepatic flexure of large intestine, although generally asymptomatic, may have different impact on manifestations of disease. During routine cadaveric study of the abdominal region we observed a case where the hepatic flexure was interposed between the right dome of the diaphragm and the anterior surface of the liver. The liver appeared bilobulated and on the anterior surface the right and left hepatic lobes were separated by a deep furrow. The left wall of the furrow was attached to the falciform ligament. We have tried to explain such high position of hepatic flexure from an embryological point of view and to evaluate its possible clinical relevance. This abnormal site of hepatic flexure could cause chronic respiratory infections, twisting of the gut, volvulus and intestinal obstruction. Moreover it may alter the normal liver dullness on percussion. So clinicians and surgeons should be aware of this variant position of the hepatic flexure.