Sphincter of Oddi

Other known aliases – hepatopancreatic sphincter, Glisson’s sphincter

Definition – muscular ring surrounding the major duodenal papilla at the 2nd portion of the duodenum.

Clinical Significance – the sphincter of Oddi allows for drainage of the biliary and pancreatic systems and dysfunction (mainly spasming) can can cause pancreatitis.  It is in a constant state of contraction unless relaxed by cholesytokinin released by vasoactive intestinal peptide.  Opioids, specifically morphine, has been shown to increase the risk of sphincter of Oddi dysfunction.

History – Named after Ruggero Ferdinando Antonio Guiseppe Vincenzo Oddi (1864-1913), who was an Italian physiologist and anatomist from Perugia.  He spent is formative years studying medicine at Perugia, Bologna, and Florence and was appointed head of the Physiology Institute at the University of Genoa in 1894.  In 1887, at only 23 years old, he described his eponymous structure in his paper “D’une disposition a sphincter speciale de l’ouverture du canal choledoque”.  His career, unfortunately, was derailed and cut short due to opioid addiction many believe was as a result of using morphine derivatives to study dysfunction of the sphincter.

References

• Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
• Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
• Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
• Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
• Up To Date. www.uptodate.com
• Helm JF, Venu RP, Geenen JE, et al. Effects of morphine on the human sphincter of Oddi. Gut. 1988; 29(10):1402-7. [pubmed]
• Behar J.  Physiology and Pathophysiology of the Biliary Tract: the Gallbladder and Sphincter of Oddi – A Review.  ISRN Physiology, vol. 2013, Article ID 837630, 15 pages, 2013. https://doi.org/10.1155/2013/837630
• Oddi R. D’une disposition a sphincter speciale de l’ouverture du canal choledoque. Arch Ital Biol. 1887;8:317–322
• Loukas M, Spentzouris G, Tubbs RS, Kapos T, Curry B. Ruggero Ferdinando Antonio Guiseppe Vincenzo Oddi. World journal of surgery. 2007; 31(11):2260-5. [pubmed]

Duct of Santorini

Other known aliases – accessory pancreatic duct

Definition – portion of the dorsal duct distal to the dorsal-ventral fusion point during embryonic development

Clinical Significance – 85% of the population have a single, main pancreatic duct and 15% can have an accessory duct that either drains into the duodenum by a separate ampulla (2/3), or drains into the main duct (1/3).  These anatomical variants need to be explored prior to instrumentation for pancreatic pathology as it can occur with pancreas divisum, which makes the accessory duct the principle drainage duct for the pancreas.

History – Named after Giovanni Domenico Santorini (1681-1737), who was an Italian anatomist and son of an apothecary.  He spent his formative years studying medicine throughout Bologna, Padua, and Pisa, where he received his medical doctorate in 1701.   He performed anatomical dissection demonstration in Venice for 23 years, during which he published his most famous work entitled Observationes Anatomicae.  This work was considered one of the most detailed and important anatomical texts of the time and gave way to descriptions of twelve different anatomic eponyms accredited to Santorini.

References

• Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
• Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
• Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
• Whonamedit – dictionary of medical eponyms.
• http://www.whonamedit.com
  
• Up To Date. www.uptodate.com

Duct of Wirsung

Other known aliases – main pancreatic duct

Definition – This is the main pancreatic duct that joins the pancreas to the common bile prior to the ampulla of Vater before emptying into the second portion of the duodenum

Clinical Significance – Having a single, major pancreatic duct is the most common anatomic variant for pancreatic anatomy, but some individuals may have an accessory duct that could be functional.  The issue with this, of course, is management of pancreatic pathology so imaging may be required prior to instrumentation or surgical management.

History – Named after Johann Georg Wirsung (1589-1643), who was a German anatomist from Padua.  He made this discovery while dissecting a criminal (Zuane Viaro) who was recently hanged for murder in 1642.  Instead of formally publishing his findings, he engraved the sketch on a copper plate so numerous casting could be made and sent to the leading anatomists of the time.  This finding is not without controversy.  One year after this discovery, Wirsung was murdered in his house late at night by a Belgian student named Giacomo Cambier over a quarrel of first discovered this duct.  In a cruel twist of fate, 5 years after his death, one of Wirsung’s students who was assisting in the dissection, Moritz Hoffman, claimed it was he who discovered this duct in a turkey rooster a year before Wirsung.

References

1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
5. Up To Date. www.uptodate.com
   
6. Howard JM, Hess W, Traverso W. Johann Georg Wirsüng (1589-1643) and the pancreatic duct: the prosector of Padua, Italy. Journal of the American College of Surgeons. 1998; 187(2):201-11. [pubmed]
   

Morison’s Pouch

Other known aliases – hepatorenal recess/fossa, right posterior subhepatic space

Definition – a potential space between the liver and the right kidney

Clinical Significance – This a space where fluid can accumulate in the setting of ascites or abdominal trauma and be seen on CT or ultrasound.  It is one of the view of a Focused Assessment of Sonography in Trauma (FAST) exam. Typically, 30-40mL of fluid needs to be present to be visualized.

History – Named after James Rutherford Morison (1853-1939), a British surgeon who received his medical degree from the University of Edinburgh in 1874.  He was also an assistant and “surgical dresser” for Joseph Lister early in his career and later founded a school of surgery at the University of Durham where he made his name as a prolific instructor of surgery.  He is well known as a pioneer of modern surgery with several of his contemporaries noting he was twenty years ahead of his time and was a driving force of he surgical arts in Great Britain at the turn of the 20th century. 

References

1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
5. Up To Date. www.uptodate.com
6. http://livesonline.rcseng.ac.uk/biogs/E004690b.htm
   

Zenker’s Diverticulum

Other Known Aliases – pharyngeal diverticulum

Definition – sac-like outpouching of the mucosa and submucosa through Killian’s triangle, which is the area of structural weakness between the cricopharyngeus and lower inferior constrictor muscles.

Clinical Significance – There are actually three different types of diverticulae that can form in this region and are based on anatomic location:

• Zenker’s – immediately above the upper esophageal sphincter
• Traction – near midpoint of the esophagus
• Epiphrenic – immediately above the lower esophageal sphincter

Signs and symptoms of a Zenker’s diverticulum are pretty awful and include dysphagia, pulmonary aspiration, and halitosis from partially rotting food in the outpoaching.  It is diagnosed via barium swallow under flouroscopy. The majority of the patients are male and present after the age of 60.  Management is surgical resection.

History – Named after Friedrich Albert von Zenker (1825-1898), who was German physician and pathologist and received his medical doctorate at Leipzig in 1851.    He held numerous teaching posts including chief prosector and professor of general pathology and anatomy at Dresden city hospital.  Dr. Zenker, along with Hugo Wilhelm von Ziemssen, published a case series and literature review on his eponymous diverticulum in 1867 entitled “Krankheiten des Oesophagus”. He also was the first to document and describe trichinosis in a girl who died in 1860, proving that the once thought harmless parasite could cause severe disease.

References

1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
5. Up To Date. www.uptodate.com
6. F. A. Zenker and Hugo Wilhelm von Ziemssen:
   Krankheiten des Oesophagus. Leipzig, 1867
7. Ueber die Trichinenkrankheit des Menschen. Virchows Archiv für pathologische Anatomie und Physiologie und für klinische Medizin, Berlin, 1860, 18: 561-572.