Liver Resection in a Patient with Absent Portal Vein Bifurcation: A Case Report
Absence of the portal bifurcation is an extremely rare anomaly and ligation of the portal vein without recognition of this anomaly would lead to tragedy. A 62-year-old man was followed up for 5 years for hepatitis type C. Computer tomography (CT) detected hepatocellular carcinoma, 6 cm in diameter,...
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| Published in | The Japanese Journal of Gastroenterological Surgery Vol. 45; no. 1; pp. 8 - 15 |
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| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
The Japanese Society of Gastroenterological Surgery
01.01.2012
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0386-9768 1348-9372 |
| DOI | 10.5833/jjgs.45.8 |
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| Abstract | Absence of the portal bifurcation is an extremely rare anomaly and ligation of the portal vein without recognition of this anomaly would lead to tragedy. A 62-year-old man was followed up for 5 years for hepatitis type C. Computer tomography (CT) detected hepatocellular carcinoma, 6 cm in diameter, in segment 5 of the liver. CT and portography revealed absent portal vein bifurcation. Originating from the right dorsal branch, the portal vein, resembling the right paramedian vein, extended up to the cranial side, divided into sent several branches in the right lobe. It turned to the left side within the parenchyma, sending medial segmental portal branches and reached the umbilical fissure. Angiography also showed absence of the proper hepatic artery. The biliary distribution had no anomaly. We performed a right anterior subsegmentectomy safely with the preoperative transcatheter arterial chemoembolization and intraoperative injection of indocyanine green from the anterior inferior branch of the portal vein. |
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| AbstractList | Absence of the portal bifurcation is an extremely rare anomaly and ligation of the portal vein without recognition of this anomaly would lead to tragedy. A 62-year-old man was followed up for 5 years for hepatitis type C. Computer tomography (CT) detected hepatocellular carcinoma, 6 cm in diameter, in segment 5 of the liver. CT and portography revealed absent portal vein bifurcation. Originating from the right dorsal branch, the portal vein, resembling the right paramedian vein, extended up to the cranial side, divided into sent several branches in the right lobe. It turned to the left side within the parenchyma, sending medial segmental portal branches and reached the umbilical fissure. Angiography also showed absence of the proper hepatic artery. The biliary distribution had no anomaly. We performed a right anterior subsegmentectomy safely with the preoperative transcatheter arterial chemoembolization and intraoperative injection of indocyanine green from the anterior inferior branch of the portal vein. |
| Author | Tamura, Toshihisa Sako, Tatsuhiko Ishikawa, Nami Hachiya, Yasutaka Hirano, Yutaka Fukuyama, Tokihiko Nakashima, Hiroshi Minagawa, Noritake Hamada, Tetsuo |
| Author_xml | – sequence: 1 fullname: Minagawa, Noritake organization: Department of Surgery, Kyushu Rousai Hospital – sequence: 1 fullname: Hachiya, Yasutaka organization: Department of Surgery, Kyushu Rousai Hospital – sequence: 1 fullname: Nakashima, Hiroshi organization: Department of Surgery, Kyushu Rousai Hospital – sequence: 1 fullname: Sako, Tatsuhiko organization: Department of Surgery, Kyushu Rousai Hospital – sequence: 1 fullname: Tamura, Toshihisa organization: Department of Surgery, Kyushu Rousai Hospital – sequence: 1 fullname: Ishikawa, Nami organization: Department of Surgery, Kyushu Rousai Hospital – sequence: 1 fullname: Fukuyama, Tokihiko organization: Department of Surgery, Kyushu Rousai Hospital – sequence: 1 fullname: Hirano, Yutaka organization: Department of Surgery, Kyushu Rousai Hospital – sequence: 1 fullname: Hamada, Tetsuo organization: Department of Pathology, Kyushu Rousai Hospital |
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| References | 14) Yamamoto H, Nagino M, Kawabata Y, Maki A, Takenouchi Y, Iwahashi N, et al. Resection of a hilar cholangiocarcinoma in a patient with absent portal bifurcation. Hepatogastroenterology. 2000 Mar-Apr;47(32):362-4. 13) Hardy KJ, Jones RM. Failure of the portal vein to bifurcate. Surgery. 1997 Feb;121(2):226-8. 17) Mitchell A, Mirza D, de Ville de Goyet J, Buckels J. Absence of the left portal vein: a difficulty for reduction of liver grafts? Transplantation. 2000 Apr 27;69(8):1731-2. 6) Fraser-Hill MA, Atri M, Bret PM, Aldis AE, Illescas FF, Herschorn SD. Intrahepatic portal venous system, Variations demonstrated with duplex and color doppler US. Radiology. 1990 Nov;177(2):523-6. 3) Couinaud C. Le foie. Etudes anastomiques et chirurgicales. Paris: Masson; 1957. 8) Rat P, Paris P, Favre JP. One liver for two: Partition of the portal elements. World J Surg. 1992;16:1167-70; discussion 1171. 11) Koh MK, Ahmad H, Watanapa P, Jalleh RP, Habib NA. Beware the anomalous portal vein. HPB Surg. 1994;7(3):237-40. 5) Hardy KJ, Nye DH. An abnormal portal vein. Surgery. 1969 Oct;66(4):676-81. 12) Charny CK, Ling P, Bolet J, Blumgart LH. Clinical observation: Congenital absence of the left portal vein in a patient undergoing hepatic resection. HPB Surg. 1997;10(5):323-6; discussion 326-7. 2) Couinaud C. Etude de la veine porte intrahepatique. Press Med. 1953;70:1434-8. 10) Kokubo T, Itoh K, Kondoh S, Kojima K, Ohtomo K. CT demonstration of a bizarre intrahepatic portal branch. J Comput Assist Tomogr. 1987 Mar-Apr;11(2):365-7. 9) Chaib E. Absence of bifurcation of the portal vein. Surg Radiol Anat. 2009 Jun;31(5):389-92. 4) Agossou-Voyeme AK. La segmentation hepatique en romedenistometrie. Paris These 3e cycle. 1982 7) Atri M, Bret PM, Fraser-Hill MA. Intrahepatic portal venous variations: prevalence with US. Radiology. 1992 Jul;184(1):157-8. 15) Cheynel N, Arnal E, Rat P, Benoit L, Trouilloud P, Favre JP. Absence of the portal bifurcation at the hilum of the liver due to intrahepatic origin of the left branch of the portal vein. Surg Radiol Anat. 2001 Sep;23(5):355-7. 16) 小竹克博，黒川 剛，大輪芳裕，稲垣 均，鍔本真里，野浪敏明．門脈左枝が右前区域より分岐する肝内血流分布異常の1例．日本臨床外科学会雑誌．2003;64(12):3113-5. 1) Couinaud C. Surgical anatomy of the liver revisited. Paris pers. Ed. 1989 |
| References_xml | – reference: 12) Charny CK, Ling P, Bolet J, Blumgart LH. Clinical observation: Congenital absence of the left portal vein in a patient undergoing hepatic resection. HPB Surg. 1997;10(5):323-6; discussion 326-7. – reference: 13) Hardy KJ, Jones RM. Failure of the portal vein to bifurcate. Surgery. 1997 Feb;121(2):226-8. – reference: 15) Cheynel N, Arnal E, Rat P, Benoit L, Trouilloud P, Favre JP. Absence of the portal bifurcation at the hilum of the liver due to intrahepatic origin of the left branch of the portal vein. Surg Radiol Anat. 2001 Sep;23(5):355-7. – reference: 2) Couinaud C. Etude de la veine porte intrahepatique. Press Med. 1953;70:1434-8. – reference: 16) 小竹克博，黒川 剛，大輪芳裕，稲垣 均，鍔本真里，野浪敏明．門脈左枝が右前区域より分岐する肝内血流分布異常の1例．日本臨床外科学会雑誌．2003;64(12):3113-5. – reference: 4) Agossou-Voyeme AK. La segmentation hepatique en romedenistometrie. Paris These 3e cycle. 1982 – reference: 5) Hardy KJ, Nye DH. An abnormal portal vein. Surgery. 1969 Oct;66(4):676-81. – reference: 9) Chaib E. Absence of bifurcation of the portal vein. Surg Radiol Anat. 2009 Jun;31(5):389-92. – reference: 7) Atri M, Bret PM, Fraser-Hill MA. Intrahepatic portal venous variations: prevalence with US. Radiology. 1992 Jul;184(1):157-8. – reference: 14) Yamamoto H, Nagino M, Kawabata Y, Maki A, Takenouchi Y, Iwahashi N, et al. Resection of a hilar cholangiocarcinoma in a patient with absent portal bifurcation. Hepatogastroenterology. 2000 Mar-Apr;47(32):362-4. – reference: 8) Rat P, Paris P, Favre JP. One liver for two: Partition of the portal elements. World J Surg. 1992;16:1167-70; discussion 1171. – reference: 11) Koh MK, Ahmad H, Watanapa P, Jalleh RP, Habib NA. Beware the anomalous portal vein. HPB Surg. 1994;7(3):237-40. – reference: 1) Couinaud C. Surgical anatomy of the liver revisited. Paris pers. Ed. 1989 – reference: 6) Fraser-Hill MA, Atri M, Bret PM, Aldis AE, Illescas FF, Herschorn SD. Intrahepatic portal venous system, Variations demonstrated with duplex and color doppler US. Radiology. 1990 Nov;177(2):523-6. – reference: 3) Couinaud C. Le foie. Etudes anastomiques et chirurgicales. Paris: Masson; 1957. – reference: 10) Kokubo T, Itoh K, Kondoh S, Kojima K, Ohtomo K. CT demonstration of a bizarre intrahepatic portal branch. J Comput Assist Tomogr. 1987 Mar-Apr;11(2):365-7. – reference: 17) Mitchell A, Mirza D, de Ville de Goyet J, Buckels J. Absence of the left portal vein: a difficulty for reduction of liver grafts? Transplantation. 2000 Apr 27;69(8):1731-2. |
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| Title | Liver Resection in a Patient with Absent Portal Vein Bifurcation: A Case Report |
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