Vol 67, No 4 (2008)
Original article
Published online: 2008-09-30
Morphologic variation of the diaphragmatic crura: a correlation with pathologic processes of the esophageal hiatus?
Folia Morphol 2008;67(4):273-279.
Abstract
The contributions of muscle fibers from the right and left diaphragmatic
crura to the formation of the esophageal hiatus have been documented in
several studies, none coming to a complete consensus on the number of
anatomic variations or the prevalence of these variations in the human population.
These variations may play a role in the pathogenicity of specific
diseases that involve the esophageal hiatus, such as hiatal hernias. We examined
a total of two hundred adult cadavers during 2000-2007. The variations
in the diaphragmatic crura, particularly their muscular contributions
to the formation of the esophageal hiatus, were grossly examined and revealed
a bilateral occurrence of diaphragmatic crura in all 200 specimens.
The results of the various morphological patterns of circumferential muscle
fibers forming the esophageal hiatus were classified into six groups. The
most common type (Type I, 45%) formed the esophageal hiatus from muscular
contributions arising solely from the right crus. In Type II (20%) the
esophageal hiatus was formed by muscular contributions from the right
and left crura. In Type III (15%), the right and left muscular contributions
arose from the right crus with an additional band from the left crus. Type IV
(10%) showed that the right and left muscular contributions arose from the
right crus, with two additional (anterior and posterior) bands arising from
the left crus. Type V (5%) demonstrated the contributions arising solely from
the left crus. In Type VI (5%) the right and left contributions originated from
the left crus with two additional bands, one from the right crus and one
from the left crus.
These variations may play a role in the pathogenicity of specific diseases that involve the esophageal hiatus such as hiatal hernia, gastroesophageal reflux disease and Dunbar’s syndrome.
These variations may play a role in the pathogenicity of specific diseases that involve the esophageal hiatus such as hiatal hernia, gastroesophageal reflux disease and Dunbar’s syndrome.
Keywords: right crusleft crusdiaphragmatic cruragastro-esophageal reflux diseaseDunbar’s syndrome