A cadaveric liver seen from above showing the sickle ligament above Now that the main ligaments attached to the upper and posterior aspects of the liver have been examined, it`s time to learn more about those that anchor the front surface. The second largest band of liver is the sickle band. The crescent-shaped ligament (as the name suggests) takes a cranioocaudal course along the anterior surface of the liver. Superior is the sickle band attached to the visceral surface of the anterior abdominal wall (only one inch to the right of the median plane) and the lower surface of the diaphragm. It is also continuous with the upper surface of the liver between the left and right lobes. On the right lobe of the liver, the anterior and posterior layers of the coronary ligament of the liver connect to form the right triangular ligament. However, there is no true coronary band on the left. Instead, the layers of the coronary leg roughly form the left triangular band. In human anatomy, the sickle ligament (from the Latin “sickle-shaped”) is a ligament that attaches the liver to the front wall of the body and divides the liver into the left and right lobes.  The sickle ligament is a broad, thin fold of the peritoneum, the base of which is directed downwards and backwards and its tip upwards and forwards. It depends on the hilum of the liver.
Physiological variants of sickle band are very rare. There have been a few case reports of sickle ligament sclerotherapy, in which the liver seemed to lack the crack that the ligament normally produces. There were also anatomical variants referring to structures carried in the sickle ligament, such as the paraumbilical veins. However, most variants are not clinically significant and would be mostly incidental findings during surgery or imaging used to diagnose another condition. In some cases, the ligament teres hepatis does not degenerate and remains obvious. Passability may also be worsened in conditions leading to portal hypertension (e.g., right ventricular failure). Teres hepatis ligament permeability can be problematic in surgical procedures where the ligament is often divided to improve field visualization (epigastric surgery) or to mobilize the liver (liver surgery). The venous ligament primarily serves as a landmark and source for controlling the left hepatic vein in dissections that require vessel control. The sickle band is the thin, sickle-shaped fibrous structure that connects the anterior part of the liver to the ventral wall of the abdomen. You can see how it hangs from the liver by looking into the abdomen during surgery. The sickle ligament adheres to the liver between the right and left lobes as well as to the inferior diaphragmatic surface.
The free lower edge of the sickle ligament contains the paraumbilical veins and the round ligament of the liver (aka ligamentum teres hepatis), which runs along a space between the lower surface of the right and left lobes. The paraumbilical veins become prominent and more open during portal hypertension, when the portal vein, which drains the gastrointestinal system, is filled with blood that cannot fully penetrate the liver. If portal hypertension is severe enough, the paraumbilical veins form a jellyfish-jellyfish of blocked blood vessels surrounding the navel. The presence of a jellyfish is a stigma of portal hypertension and severe liver dysfunction, as seen in end-stage liver disease. (Note: When using the short-term term “round ligament” versus “round ligament of the liver,” the term should not be confused with the round ligament of the uterus.) The blood supply to the sickle ligament is variable, but is usually provided by the left lower phrenic and/or middle hepatic arteries. The inferior left phrenic vein drains the sickle ligament. The superficial lymphatic vessels of the liver drain lymph from the sickle ligament. Due to its close connection to the liver, it is possible for infections and malignant tumors to be transmitted to the sickle band through its blood supply and/or lymphatic vessels.
The hepatic porta, which carries the neurovascular bundle with the common hepatic duct, the actual hepatic artery, the hepatic portal vein and the autonomic axons in the liver, is located in a fissure on the underside of the extreme left side of the right lobe. Due to the proximity of portal hepatitis to the round ligament of the liver, infections or carcinomas in the hepatic portal can penetrate the sickle ligament.  In addition, the superficial lymphatic vessels of the liver can carry infections or malignant tumors from surrounding structures and sow sickle cell ligament.  In utero, the venous duct was responsible for pushing blood from the left portal vein into the left hepatic vein, bypassing hepatic circulation. During the first week of ectopic life, the venous duct degenerates and becomes the ligamentum venosum. This thin fibrous cord runs from the left branch of the portal vein upwards into the pit, which bears its name, to reach the inferior vena cava. The smallest omentum forms an L-shaped approach that extends from the distal segment of the abdominal esophagus along the smallest curvature of the stomach to the upper (first part) of the duodenum. It is deposited on the lower surface of the liver, adjacent to the fissure of the ligamentum venosum and porta hepatis. Neoplasms with perivascular epithelial cell differentiation (PEComas) include tumors such as angiomyolipomas, clear cell tumors of the lungs and lymphangiomyomatosis, myelomelanocyte cell tumors with clear cells of the sickle band and other unusual clear cell tumors. PEComas consist of epithelioid and fusiform cells arranged around thin-walled blood vessels.
Cells have clear to granular cytoplasm and have small round to oval nuclei and small nucleoli (Fig. 18.25A). Pronounced atypia, mitotic figures and necrosis can be observed. Cytological preparations are mainly cellular and consist mainly of individual cells with occasional clusters. The cells range from spindle to epitheloid in morphology. Many naked nuclei released from the cytoplasm are present. The nuclei are usually round with minimal atypia and have prominent focal nucleoli. The nuclei are centrally located or eccentric, with occasional binucleation or multinucleation. The cytoplasm is vacuolized or basophilic variably in non-vacuolized cells when evaluated with Pap stained preparations. Distinct smooth cytoplasmic margins are observed in Giemsa`s air-colored slides (Fig. 18.25B).
The hemosiderin pigment can be seen in tumor cells. In a minority of cases, thick-walled vessels are detected.142–145 Immunoreactivity of smooth muscle actin and HMB-45 is useful in determining sample type. Triangular ligaments are asymmetrical bilateral structures that help hold the liver in place.