title: Resection of metastatic liver cancer in a patient with a left-sided gallbladder and intrahepatic portal vein and bile duct anomalies: A case report.
abstract: BACKGROUND
  The presence of left-sided gallbladder is closely associated with multiple combined anomalies of the portal vein, hepatic vein, hepatic artery, and bile duct. This requires special attention for preoperative evaluation for the purpose of preventing postoperative complications.
  
  
  METHODS
  A 70-year-old woman with metastatic liver cancer and intrahepatic portal vein, biliary system and hepatic artery anomalies with left-sided gallbladder is reported. On computed tomography (CT), a solitary low density mass occupied from the right anterior to the posterior segment of the liver. The gallbladder bed was on the left of the hepatic fissure. On drip-infusion-cholangiography (DIC) CT three-dimensional (3D) reconstruction, the left medial bile duct arose from the right umbilical portion after arising from the left lateral bile duct. Following a right hepatectomy and lymph node dissection of the hepatoduodenal ligament, hepaticojejunostomy was conducted separately to the left medial and left lateral bile duct.
  
  
  CONCLUSIONS
  The left-sided gallbladder accompanies with several anomalies of hepatic vascular and bile duct anomalies in a frequent manner. A safe hepatectomy needs accurate operative plans to ascertain the range of hepatectomy, because it often has the diversity of a combined anomaly.
  
  
  CONCLUSIONS
  Preoperative DIC-CT 3D reconstruction was extremely useful because it provided an important information that could not be obtained with 2D-DIC-CT. 3D imaging has the ability to demonstrate complex anatomical relationships, this devise is a effective new tool for making appropriate preoperative strategy.
authors.affiliation: Department of Surgery, Iizuka Hospital, 3-83 Yoshio-machi, Iizuka-shi, Fukuoka 820-8505, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Abe
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Kajiyama
authors.forename: Norifumi
authors.initials: N
authors.lastname: Harimoto
authors.forename: Tomonobu
authors.initials: T
authors.lastname: Gion
authors.forename: Ken
authors.initials: K
authors.lastname: Shirabe
authors.forename: Takashi
authors.initials: T
authors.lastname: Nagaie