Postgastrectomy development or accentuation of focal fatty change in segment IV of the liver: correlation with the presence of aberrant venous branches of the parabiliary venous plexus.
BACKGROUND
Focal fatty change in segment IV (S4) of the liver is occasionally a diagnostic dilemma in the postoperative follow-up of gastric cancer patients.


OBJECTIVE
To determine whether development of focal fatty change in S4 is related to the presence of aberrant venous branches of the parabiliary venous plexus (PBP).


METHODS
Two hundred seventy-six patients with gastrectomy who had been imaged by thin-slice preoperative computed tomography (CT) and at least one postoperative CT, and had no apparent liver masses were retrospectively analyzed. Preoperative CT were evaluated for the presence of aberrant venous branches of PBP entering S4. Serial postoperative CTs were evaluated for any interval change in the appearance of S4 of the liver.


RESULTS
There were 6 patients out of 276 (2%) in whom focal fatty liver developed or accentuated after the surgery. In 5 out of the 6, preoperative CT demonstrated aberrant branches of PBP; 3 of these were suggested to be aberrant right gastric veins, and the etiologies were not determined in 2. In 1 case, no definite aberrant vessel was seen. Aberrant vessels were found in none of the remaining 270 patients. The incidence of aberrant vessels was significantly higher in patients who developed postoperative radiologic change in S4 than in those who did not (P<0.0001).


CONCLUSIONS
Development or accentuation of focal fatty liver in S4 of the liver was observed in 2% of postgastrectomy patients and was closely related to the presence of aberrant venous branches of PBP.
Yoshimitsu
Kengo
K
Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University 3-1-1, Maidashi Higashi-ku, Fukuoka 812-8582, Japan. yoshimitsu@dr.hosp.kyushu-u.ac.jp
Irie
Hiroyuki
H
Kakihara
Daisuke
D
Tajima
Tsuyoshi
T
Asayama
Yoshiki
Y
Hirakawa
Masakazu
M
Ishigami
Kousei
K
Noshiro
Hirokazu
H
Kakeji
Yoshihiro
Y
Honda
Hiroshi
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001659:Biliary Tract / Q000098:blood supply*; D005234:Fatty Liver / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008099:Liver / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014680:Veins / Q000002:abnormalities