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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

Magnetic resonance cholangiopancreatography image superimposed by the pre-planned hepatic transection plane (dotted line).
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Figure 4: Magnetic resonance cholangiopancreatography image superimposed by the pre-planned hepatic transection plane (dotted line).

Mentions: After dissection of the hilar structures, 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. After transecting the distal bile duct at the level of the pancreas, we found that there was no vascular invasion of the right-sided liver. Thus, the extent of liver resection included extended left lateral sectionectomy (Figs. 4, 5). Through the anterior transection approach without the hanging maneuver, the liver was transected and the bile duct was resected en bloc. The right-sided bile duct orifice in the liver was 8 mm in size and single, and probing exploration revealed that it was the common-channel bile duct confluence of the above-mentioned three sections in the right-sided liver. The resection margin was tumor-negative on frozen-section biopsy. Since only the left-sided wall of the umbilical portion of the portal vein was partially invaded by the tumor, the involved portion was excised and then covered with a remnant branch patch after excision of a small adjacent portal vein branch in the left medial section (Fig. 5).


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)

Magnetic resonance cholangiopancreatography image superimposed by the pre-planned hepatic transection plane (dotted line).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Magnetic resonance cholangiopancreatography image superimposed by the pre-planned hepatic transection plane (dotted line).
Mentions: After dissection of the hilar structures, 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. After transecting the distal bile duct at the level of the pancreas, we found that there was no vascular invasion of the right-sided liver. Thus, the extent of liver resection included extended left lateral sectionectomy (Figs. 4, 5). Through the anterior transection approach without the hanging maneuver, the liver was transected and the bile duct was resected en bloc. The right-sided bile duct orifice in the liver was 8 mm in size and single, and probing exploration revealed that it was the common-channel bile duct confluence of the above-mentioned three sections in the right-sided liver. The resection margin was tumor-negative on frozen-section biopsy. Since only the left-sided wall of the umbilical portion of the portal vein was partially invaded by the tumor, the involved portion was excised and then covered with a remnant branch patch after excision of a small adjacent portal vein branch in the left medial section (Fig. 5).

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