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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

Gross photographs of the operative field after resection (A) and the resected specimen (B).
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Figure 6: Gross photographs of the operative field after resection (A) and the resected specimen (B).

Mentions: Pathological examination revealed that the final diagnosis was moderately differentiated adenocarcinoma involving the liver with vascular invasion of the left hepatic artery and left portal vein, concurrent perineural invasion without lymphovascular invasion, and lymph node metastasis in 5 out of 12 nodes (Fig. 6). Thus, tumor staging was T3N1M0, being stage IIIB according the 7th edition of the American Joint Committee on Cancer (AJCC) staging system.


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)

Gross photographs of the operative field after resection (A) and the resected specimen (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 6: Gross photographs of the operative field after resection (A) and the resected specimen (B).
Mentions: Pathological examination revealed that the final diagnosis was moderately differentiated adenocarcinoma involving the liver with vascular invasion of the left hepatic artery and left portal vein, concurrent perineural invasion without lymphovascular invasion, and lymph node metastasis in 5 out of 12 nodes (Fig. 6). Thus, tumor staging was T3N1M0, being stage IIIB according the 7th edition of the American Joint Committee on Cancer (AJCC) staging system.

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