Doppler sonography in hepatolithiasis: a case report.
In the treatment of hepatolithiasis, it is important to not only remove all stones and eliminate bile stasis in the biliary tract, but also to remove atrophic hepatic tissue, as such tissue may cause recurrent cholangitis as well as latent cholangiocarcinoma. A 75-year-old woman was diagnosed as having hepatolithiasis with stenosis at the branching of the bile ducts in segment II and segment III by sonography, computed tomography, endoscopic retrograde cholangiography, and magnetic resonance cholangiography. Portograms did not reveal portal branches in segment III but did demonstrate the portal branches in segment II. During the operation, Doppler sonography was done. Doppler sonography did not reveal the portal blood flow in segment III, but did demonstrate a "to-and-fro" pattern in the portal branches in segment II, indicating atrophic hepatic tissue with disrupted portal blood flow. Lateral segmentectomy (resection of segments II and III and lithotomy with choledo-chotomy were done. The patient is in good health 2 years 6 months after the operation. Doppler sonography is useful in the detection of disrupted portal blood flow and the diagnosis of hepatic atrophy. This is clearly advantageous in the decision-making about whether to perform a liver resection with hepatolithiasis.
Kubo
S
S
Second Department of Surgery, Osaka City University Medical School, Japan.
Hamba
H
H
Hirohashi
K
K
Tsukamoto
T
T
Kinoshita
H
H
D000368:Aged; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002769:Cholelithiasis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D002780:Cholestasis, Intrahepatic / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008102:Liver Circulation / Q000502:physiology; D011169:Portal Vein / Q000000981:diagnostic imaging; D018608:Ultrasonography, Doppler