Left-sided Gallbladder with Intrahepatic Portal Vein Anomalies: A Single Center Experiences

  • Kim, Eun-Jin (Departments of Surgery Hanyang University College of Medicine) ;
  • Lee, Jae-Hoon (Departments of Surgery Hanyang University College of Medicine) ;
  • Song, Soon-Young (Departments of Radiology, Hanyang University College of Medicine) ;
  • Lee, Kyeong-Geun (Departments of Surgery Hanyang University College of Medicine) ;
  • Park, Hwon-Kyum (Departments of Surgery Hanyang University College of Medicine) ;
  • Lee, Kwang-Soo (Departments of Surgery Hanyang University College of Medicine)
  • Published : 2010.12.31

Abstract

Purpose: The goal of this article was to characterize and explain the etiology of a left-sided gallbladders with intrahepatic portal vein anomalies, and these cases of this unusual anatomy were all encountered at a single center. Methods: We reviewed the movies recorded during surgery, the database information and the preoperative radiologic examinations of 1,141 patients who underwent cholecystectomies at our institution between August 2007 and July 2010 to assess the presence of left-sided gallbladder and its combined anomalies. Results: Four of 1141 patients (0.35%) were diagnosed with left-sided gallbladder. In all the cases, the gallbladder was located on the left side of the falciform ligament, under the left lobe of the liver with typical abnormal intrahepatic portal venous branching. The right posterior portal vein came directly from the main portal vein, and the right anterior portal vein originated from the left portal vein, but the ligamentum teres joined to the left branch of the portal vein in the liver. Conclusion: Left-sided gallbla dder with intrahepatic portal venous branching anomaly resulted from the defective development of the central portion of the liver rather than from abnormal regression of the left umbilical vein with persistence of the right umbilical vein.

Keywords

References

  1. Hochstetter F. Anomalies of the portal vein and of the umbilical vein related to a defect or to a left-sided gallbladder. Arch Anat Entwick 1886;369-384.
  2. Rocca JP, Rodriguez-Davalos MI, Burke-Davis M, Marvin MR, Sheiner PA, Facciuto ME. Living-donor hepatectomy in right-sided round-ligament liver: importance of mapping the anatomy to the left medial segment. J Hepatobiliary Pancreat Surg 2006;13:454-457. https://doi.org/10.1007/s00534-005-1094-9
  3. Nagai M, Kubota K, Kawasaki S, Takayama T, Bandai Y, Makuuchi M. Are left-sided gallbladders really located on the left side? Ann Surg 1997;225:274-280. https://doi.org/10.1097/00000658-199703000-00006
  4. Gross RE. Congenital anomalies of the gallbladder. A review of 148 cases, with report of a double gallbladder. Arch Surg 1936;32:131-162. https://doi.org/10.1001/archsurg.1936.01180190134008
  5. Idu M, Jakimowicz J, Iuppa A, Cuschieri A. Hepatobiliary anatomy in patients with transposition of the gallbladder: implications for safe laparoscopic cholecystectomy. Br J Surg 1996;83:1442-1443. https://doi.org/10.1002/bjs.1800831037
  6. Maetani Y, Itoh K, Kojima N, et al. Portal vein anomaly associated with deviation of the ligamentum teres to the right and malposition of the gallbladder. Radiology 1998;207: 723-728. https://doi.org/10.1148/radiology.207.3.9609896
  7. Asonuma K, Shapiro AM, Inomata Y, Uryuhara K, Uemoto S, Tanaka K. Living related liver transplantation from donors with the left-sided gallbladder/portal vein anomaly. Transplantation 1999;68:1610-1612. https://doi.org/10.1097/00007890-199911270-00031
  8. Baba Y, Hokotate H, Nishi H, Inoue H, Nakajo M. Intrahepatic portal venous variations: demonstration by helical CT during arterial portography. J Comput Assist Tomogr 2000;24:802-808. https://doi.org/10.1097/00004728-200009000-00024
  9. McNulty JG, Khosa F. Absence of bifurcation of the portal vein. Radiology 1999;211:589-590. https://doi.org/10.1148/radiology.211.2.r99ma10589
  10. Cheng YF, Chen TY, Ko SF, et al. Treatment of postoperative residual hepatolithiasis after progressive stenting of associated bile duct strictures through the T-tube tract. Cardiovasc Intervent Radiol 1995;18:77-81. https://doi.org/10.1007/BF02807226
  11. Hsu SL, Chen TY, Huang TL, et al. Left-sided gallbladder: its clinical significance and imaging presentations. World J Gastroenterol 2007;13:6404-6409. https://doi.org/10.3748/wjg.13.6404
  12. Blumgart LH, Baer HU, Czerniak A, Zimmermann A, Dennison AR. Extended left hepatectomy: technical aspects of an evolving procedure. Br J Surg 1993;80:903-906. https://doi.org/10.1002/bjs.1800800735
  13. Cheng YF, Huang TL, Chen CL, et al. Anatomic dissociation between the intrahepatic bile duct and portal vein: risk factors for left hepatectomy. World J Surg 1997;21:297-300. https://doi.org/10.1007/s002689900232
  14. Boyden EA. The accessory gall-bladder-an embryological and comparative study of aberrant biliary vesicles occurring in a man and the domestic mammals. Am J Anat 1926;38: 177-231. https://doi.org/10.1002/aja.1000380202
  15. Couinand C. Surgical anatomy of the liver revisited. Paris: Couinaud; 1989.
  16. Arey LB. Developmental anatomy. A textbook and laboratory manual of embryology. 7th ed. Philadelphia: WB Saunders; 1965.
  17. Dhulkotia A, Kumar S, Kabra V, Shukla HS. Aberrant gallbladder situated beneath the left lobe of liver. HPB (Oxford) 2002;4:39-42.
  18. Uesaka K, Yasui K, Morimoto T, et al. Left-sided gallbladder with intrahepatic portal venous anomalies. J Hepatobiliary Pancreat Surg 1995;2:425-430. https://doi.org/10.1007/BF02349262
  19. Gallego C, Velasco M, Marcuello P, Tejedor D, De Campo L, Friera A. Congenital and acquired anomalies of the portal venous system. Radiographics 2002;22:141-159.
  20. Kawai K, Koizumi M, Honma S, Tokiyoshi A, Kodama K. Right ligamentum teres joining to the right branch of the portal vein. Anat Sci Int 2008;83:49-54. https://doi.org/10.1111/j.1447-073X.2007.00168.x
  21. Savier E, Taboury J, Lucidarme O, et al. Fusion of the planes of the liver: an anatomic entity merging the midplane and the left intersectional plane. J Am Coll Surg 2005;200:711-719. https://doi.org/10.1016/j.jamcollsurg.2004.12.017