IJAR.2025.240
Type of Article: Case Report
Volume 13; Issue 4 (December 2025)
Page No.: 9361-9367
DOI: https://dx.doi.org/10.16965/ijar.2025.240
A Potentially Hazardous Superficial Ulnar Artery, Supernumerary Lung Fissures, Undescended Caecum and Many More– A Cadaveric Case Report of Multiple Anomalies
Rahe Rajan *1, Renuka Devi M.R 2, Durga Devi 3, Devaki P.R 4, Jinu Merlin Koshy 5.
*1 Professor, Department of Anatomy, Sree Balaji Medical College and Hospital, Chennai, India. ORCiD: 0000-0002-0487-0412
2 Professor, Department of Physiology, Sree Balaji Medical College and Hospital, Chennai, India. ORCiD: 0000-0003-0675-2900
3 Professor, Department of Anatomy, Sree Balaji Medical College and Hospital, Chennai, India ORCiD: 0000-0003-1852-8711
4 Professor and Head, Department of Physiology, Sree Balaji Medical College and Hospital, Chennai, India. ORCiD: 0000-0002-3590-2464
5 Associate professor, Department of Anatomy, Sree Balaji Medical College and Hospital, Chennai, India. ORCiD: 0000-0002-2072-6576
Corresponding Author: Dr Rahe Rajan, Professor, Department Of Anatomy, Sree Balaji Medical College And Hospital (Biher), No 7, Clc Works Road, Chrompet, Chennai – 600044, Tamil Nadu, India. E-Mail: drrahee12@gmail.com
ABSTRACT
Introduction: Anatomical anomalies, though often isolated, can occasionally present as multiple deviations within a single individual, offering valuable insight into the complexity and diversity of human anatomy.
Case report: This cadaveric case report details a rare combination of anatomical variations observed during routine dissection at a tertiary care medical college in Chennai in 2025. A 68-year-old male cadaver was found to have four distinct anomalies: a superficial ulnar artery (SUA) arising from the axillary artery; a supernumerary fissure in the right lung creating a fourth lobe; an undescended caecum and appendix located in the subhepatic region; and bilateral absence of the plantaris muscle. The superficial ulnar artery followed an unusual superficial course, increasing the risk of iatrogenic injury during procedures such as venipuncture or intravenous cannulation. The supernumerary fissure, categorized under Craig & Walker Type II classification, divided the inferior lobe of the right lung, a variation that may complicate pulmonary surgery. The subhepatic positioning of the caecum and appendix, while often asymptomatic, could mimic hepatobiliary pathology and present diagnostic challenges in cases of acute appendicitis. Conclusion: This report contributes to the growing body of literature on anatomical variations by documenting a unique confluence of multiple anomalies not previously reported together. Recognition and understanding of these variations are crucial in preoperative planning, imaging interpretation, and surgical safety.
Key words: Superficial Ulnar Artery, Sub Hepatic Caecum, Accessory Lobes In Lung, Multiple Anomalies.
REFERENCES
[1]. Kühnel, W., Schünke, M., & Putz, R. (2004). Clinical Anatomy: A Revision Guide. Elsevier.
[2]. Williams, A. P., Smith, P. P., & Ross, M. S. Multiple Congenital Anomalies: A Case Report. Journal of Anatomy and Physiology 2013;58(2):110-115.
[3]. Natsis K, Papadopoulou AL, Paraskevas G, Totlis T, Tsikaras P. High origin of a superficial ulnar artery arising from the axillary artery: anatomy, embryology, cinical significance and a review of the literature. Folia morphologica. 2006;65(4):400-5.
[4]. Craig SR, Walker WS. A proposed anatomical classification of the pulmonary fissures. Journal of the Royal College of Surgeons of Edinburgh. 1997 Aug 1;42(4):233-4.
[5]. Patel, V. B., Patel, R. R., & Lister, A. M. Anomalous Anatomy and Its Implications for Surgical Practice: Case Reports and Review. Clinical Anatomy, 2017;30(7):847-853.
https://doi.org/10.1093/jscr/rjx045
[6]. Rodríguez-Niedenführ, M., Vazquez, T., Nearn, L., Ferreira, B., Parkin, I., & Sañudo, J. R. Variations of the arterial pattern in the upper limb revisited: a morphological and statistical study, with a review of the literature. Journal of Anatomy, 2001; 199(5): 547-566.
https://doi.org/10.1046/j.1469-7580.2001.19950547.x
PMid:11760886 PMCid:PMC1468366
[7]. McCormack, L. J., Cauldwell, E. W., & Anson, B. J. Brachial and antebrachial arterial patterns: a study of 750 extremities. Surgery, Gynecology & Obstetrics, 1953;96(1):43-54.
[8]. Hazlett, J. W. The superficial ulnar artery with reference to accidental intra-arterial injection. Canadian Medical Association Journal, 1949;61(3):289-293.
[9]. Senanayake KJ, Salgado S, Rathnayake MJ, Fernando R, Somarathne K. A rare variant of the superficial ulnar artery, and its clinical implications: a case report. J Med Case Rep. 2007;1:128.
https://doi.org/10.1186/1752-1947-1-128
PMCid:PMC2186348
[10]. Sato K, Murakami K, Mimata Y, Kikuchi Y, Oikawa R, Doita M. Superficial ulnar artery crossing over the palmaris longus tendon at the wrist in a cadaver: a case report. J Hand Surg Asian Pac. 2018;23(1):137-9.
https://doi.org/10.1142/S2424835518720074
[11]. Pattani S, Irshad S, Sewo L, Dacquel M, Narayan V, Dhiman S. Case Study: Superficial Ulnar Artery and its Clinical Significance. FASEB J. 2022;36(S1):L8045.
https://doi.org/10.1096/fasebj.2022.36.S1.L8045
[12]. Azuma S, Nakamura M, Sato K, Honda T, Sakuraba M. The First Clinical Case of Repairing Superficial Ulnar Artery Injury. J Plast Reconstr Aesthet Surg. 2023;2(2):49-52.
https://doi.org/10.53045/jprs.2021-0020
PMid:40385076 PMCid:PMC12078107
[13]. Sakulsak N, Phuapittayalert L. An unusual topographic relationship between high origin of superficial ulnar artery and bitendinous palmaris longus. Anat Sci Int. 2021;96(4):577-81.
https://doi.org/10.1007/s12565-021-00608-9
PMid:33543450
[14]. Clarke E. Anatomical variations of the superficial ulnar artery: case series observed on historical specimens prepared by Ludwik Karol Teichmann. Folia Morphol (Warsz). 2021;80(1):1-7.
https://doi.org/10.5603/FM.a2021.0014
PMid:33577075
[15]. Lippert, H., & Pabst, R. (1985). Arterial Variations in Man: Classification and Frequency. Munich: J.F. Bergmann-Verlag.
https://doi.org/10.1007/978-3-642-80508-0
PMCid:PMC481822
[16]. Ukoha, U. U., et al. High origin and superficial course of ulnar artery: a potential hazard during venipuncture. Oman Medical Journal, 2013;28(2):135-136. https://doi.org/10.5001/omj.2013.34
PMCid:PMC3628194
[17]. Nayak, S. R., et al. Superficial ulnar artery-a case report and review of the literature. Folia Morphologica, 2008;67(4):246-249.
[18]. Singer, E. Embryological pattern persisting in the arteries of the arm. The Anatomical Record, 1933;55(4):403-409.
https://doi.org/10.1002/ar.1090550407
[19]. Yamada, T., Gloviczki, P., Bower, T. C., et al. Vascular anomalies and the risk of inadvertent arterial puncture during venous access procedures. Journal of Vascular Surgery, 2008;47(4):929-935.
[20]. Godwin JD, Tarver RD. Accessory fissures of the lung. AJR Am J Roentgenol. 1985;144(1):39-47.
https://doi.org/10.2214/ajr.144.1.39
PMid:3871146
[21]. Sucu HK, Tatar F, Yigit O, et al. The surgical importance of the accessory fissures of the lung: a report of two cases. Clin Anat. 2008;21(6):501-503. doi:10.1002/ca.20651
https://doi.org/10.1002/ca.20651
PMid:18773476
[22]. Sadler TW. Langman’s Medical Embryology. 14th ed. Wolters Kluwer; 2019.
[23]. Moore KL, Persaud TVN, Torchia MG. The Developing Human: Clinically Oriented Embryology. 11th ed. Elsevier; 2015.
[24]. Baldisserotto M, Marchiori E, Condessa F, et al. Subhepatic appendicitis in children: the role of ultrasound. Pediatr Radiol. 2000;30(9):605-607.
[25]. Palle P, Ramavath K, Sindhu N, et al. Sub hepatic acute appendicitis: a challenging case to diagnose and successfully managed by laparoscopic procedure. Int Surg J. 2021;8(5):1735-8.
https://doi.org/10.18203/2349-2902.isj20214398
[26]. Sekendar Ali SK, Mukhopadhyay NN. Emergency surgical management of sub-hepatic appendicular perforation with abscess; rare presentation of a common disease: a case report. Int J Res Med Sci. 2021;9(3):10175-8.
https://doi.org/10.18203/2320-6012.ijrms20214434
[27]. Papageorgopoulou C, Nikolakopoulos K, Seretis C. Acute Appendicitis in the Context of Undescended Cecum: Laparoscopic Management with Restoration of the Orthotopic Anatomy. Surgery, Gastroenterol Oncol. 2022;27(2):e472.
https://doi.org/10.21614/sgo-472
[28]. Yousef A, Suleimanov M. Subhepatic appendicitis: a diagnostic challenge. Radiol Case Rep. 2022;17(12):4777-80.
[29]. Malik S, Saeed F, Haider A. Subhepatic appendix: a diagnostic dilemma in a child. Prof Med J. 2022;29(5):721-4.
[30]. Anelay BA, Chekol AM, Tigabie W, Sintayew M, Tadesse E. Malrotated subhepatic caecum with subhepatic appendicitis: Diagnostic dilemma: A case report. Int J Surg Case Rep. 2024;123:110320.
https://doi.org/10.1016/j.ijscr.2024.110320
PMid:39303487 PMCid:PMC11437740
[31]. Hansraj S, Dube R, Yadav K. Recurrent appendicitis due to paracolic subhepatic appendix: a rare anomaly. Int Surg J. 2024;11(3):1161-3.
[32]. Anelay J, Salles D, Estrada J. Malrotated subhepatic cecum with gangrenous appendicitis. Cureus. 2024;16(1):e51562.
[33]. Charo Q, Nyamuryekung’e KK, Chacha J. A rare sigmoid and cecum colon volvulus: a case report. J Med Case Rep. 2024;18(1):77.
https://doi.org/10.1186/s13256-024-04622-z
[34]. Shetty RR, Bhat K, Kumar N. Anatomical Variations in a Cadaver: A Case Report. J Evolution Med Dent Sci. 2025;12(4):698-701.
[35]. Pickhardt PJ, Bhalla S. Intestinal malrotation in adolescents and adults: spectrum of clinical and imaging features. AJR Am J Roentgenol. 2002;179(6):1429-1435.
https://doi.org/10.2214/ajr.179.6.1791429
PMid:12438031
