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Customized left-sided hepatectomy and bile duct resection for perihilar cholangiocarcinoma in a patient with left-sided gallbladder and multiple combined anomalies.

Almodhaiberi H, Hwang S, Cho YJ, Kwon Y, Jung BH, Kim MH - Korean J Hepatobiliary Pancreat Surg (2015)

Bottom Line: Left-sided gallbladder (LSGB) is a rare anomaly, but it is often associated with multiple combined variations of the liver anatomy.Due to anatomical variation of the biliary system, only one right-sided duct was reconstructed.The patient recovered uneventfully without any complication.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. ; Department of Hepatobiliary and Liver Transplant Unit, General Surgery Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.

ABSTRACT
Left-sided gallbladder (LSGB) is a rare anomaly, but it is often associated with multiple combined variations of the liver anatomy. We present the case of a patient with LSGB who underwent successful resection of perihilar cholangiocarcinoma. The patient was a 67-year-old male who presented with upper abdominal pain and obstructive jaundice. Initial imaging studies led to the diagnosis of Bismuth-Corlette type IIIB perihilar cholangiocarcinoma. Due to the unique location of the gallbladder and combined multiple hepatic anomalies, LSGB was highly suspected. During surgery after hilar dissection, we recognized that the tumor was located at the imaginary hilar bile duct bifurcation, but its actual location was corresponding to the biliary confluence of the left median and lateral sections. The extent of resection included extended left lateral sectionectomy, caudate lobe resection, and bile duct resection. Since some of the umbilical portion of the portal vein was invaded, it was resected and repaired with a portal vein branch patch. Due to anatomical variation of the biliary system, only one right-sided duct was reconstructed. The patient recovered uneventfully without any complication. LSGB should be recognized as a constellation of multiple hepatic anomalies, and therefore, thorough investigations are necessary to enable the performance of safe hepatic and biliary resections.

No MeSH data available.


Related in: MedlinePlus

Computed tomography image indicating the possible presence of the left-sided gallbladder (arrow).
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Figure 2: Computed tomography image indicating the possible presence of the left-sided gallbladder (arrow).

Mentions: This case was of a 67-year-old male patient who presented with upper abdominal pain and obstructive jaundice. Laboratory examination on admission showed serum total bilirubin level of 9.6 mg/dl. Abdominal computed tomography (CT) and magnetic resonance imaging revealed Bismuth-Corlette type IIIB perihilar cholangiocarcinoma with left portal vein and left hepatic artery invasion, type III portal vein variation, dilated right intrahepatic bile duct, and left liver lobe atrophy (Fig. 1). Due to the unique location of the gallbladder and combined multiple hepatic anomalies, presence of LSGB was highly suspected (Fig. 2). The branching pattern of the portal vein appeared strange compared with the usual type III portal vein variation, in which the liver appeared to be divided into 3 parts; the right posterior section, the right anterior section integrated with the left medial section, and the left lateral section (Fig. 3). For biliary decompression, endoscopic nasobiliary drainage was performed following endoscopic retrograde cholangiography. Surgery was performed when the serum total bilirubin level was 1.7 mg/dl.


Customized left-sided hepatectomy and bile duct resection for perihilar cholangiocarcinoma in a patient with left-sided gallbladder and multiple combined anomalies.

Almodhaiberi H, Hwang S, Cho YJ, Kwon Y, Jung BH, Kim MH - Korean J Hepatobiliary Pancreat Surg (2015)

Computed tomography image indicating the possible presence of the left-sided gallbladder (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4494093&req=5

Figure 2: Computed tomography image indicating the possible presence of the left-sided gallbladder (arrow).
Mentions: This case was of a 67-year-old male patient who presented with upper abdominal pain and obstructive jaundice. Laboratory examination on admission showed serum total bilirubin level of 9.6 mg/dl. Abdominal computed tomography (CT) and magnetic resonance imaging revealed Bismuth-Corlette type IIIB perihilar cholangiocarcinoma with left portal vein and left hepatic artery invasion, type III portal vein variation, dilated right intrahepatic bile duct, and left liver lobe atrophy (Fig. 1). Due to the unique location of the gallbladder and combined multiple hepatic anomalies, presence of LSGB was highly suspected (Fig. 2). The branching pattern of the portal vein appeared strange compared with the usual type III portal vein variation, in which the liver appeared to be divided into 3 parts; the right posterior section, the right anterior section integrated with the left medial section, and the left lateral section (Fig. 3). For biliary decompression, endoscopic nasobiliary drainage was performed following endoscopic retrograde cholangiography. Surgery was performed when the serum total bilirubin level was 1.7 mg/dl.

Bottom Line: Left-sided gallbladder (LSGB) is a rare anomaly, but it is often associated with multiple combined variations of the liver anatomy.Due to anatomical variation of the biliary system, only one right-sided duct was reconstructed.The patient recovered uneventfully without any complication.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. ; Department of Hepatobiliary and Liver Transplant Unit, General Surgery Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.

ABSTRACT
Left-sided gallbladder (LSGB) is a rare anomaly, but it is often associated with multiple combined variations of the liver anatomy. We present the case of a patient with LSGB who underwent successful resection of perihilar cholangiocarcinoma. The patient was a 67-year-old male who presented with upper abdominal pain and obstructive jaundice. Initial imaging studies led to the diagnosis of Bismuth-Corlette type IIIB perihilar cholangiocarcinoma. Due to the unique location of the gallbladder and combined multiple hepatic anomalies, LSGB was highly suspected. During surgery after hilar dissection, we recognized that the tumor was located at the imaginary hilar bile duct bifurcation, but its actual location was corresponding to the biliary confluence of the left median and lateral sections. The extent of resection included extended left lateral sectionectomy, caudate lobe resection, and bile duct resection. Since some of the umbilical portion of the portal vein was invaded, it was resected and repaired with a portal vein branch patch. Due to anatomical variation of the biliary system, only one right-sided duct was reconstructed. The patient recovered uneventfully without any complication. LSGB should be recognized as a constellation of multiple hepatic anomalies, and therefore, thorough investigations are necessary to enable the performance of safe hepatic and biliary resections.

No MeSH data available.


Related in: MedlinePlus