title: Left hepatic trisectionectomy for hepatolithiasis with occluded left and right anterior branches of the portal vein: report of a case.
abstract: A 64-year-old male was admitted to a local hospital with epigastric pain. Diagnostic imaging revealed hepatolithiasis in the atrophic left lobe. However, endoscopic intervention was impossible because of the presence of many large stones. He was referred to our hospital for surgical treatment. Enhanced multidetector-row computed tomography revealed that the right posterior portal vein (PV) was branched from the portal trunk as a first-order branch, and the bile duct of segment 3 ran caudally to the umbilical portion of the left PV. Furthermore, the umbilical portion of the left PV, which was located between the dilated bile ducts of segment 2 and segment 3, and also the right anterior PV, was occluded with thrombus. Based on these findings, he underwent left hepatic trisectionectomy. Although the indications for left hepatic trisectionectomy for hepatolithiasis are limited, it is therefore extremely important to determine the most appropriate surgical procedure based on the anatomy and findings of hepatic hilus in individual cases.
authors.affiliation: Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan.
authors.forename: Isamu
authors.initials: I
authors.lastname: Hosokawa
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shimizu
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yoshidome
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ohtsuka
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kato
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Yoshitomi
authors.forename: Katsunori
authors.initials: K
authors.lastname: Furukawa
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Takayashiki
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kuboki
authors.forename: Daiki
authors.initials: D
authors.lastname: Okamura
authors.forename: Daisuke
authors.initials: D
authors.lastname: Suzuki
authors.forename: Masayuki
authors.initials: M
authors.lastname: Nakajima
authors.forename: Masaru
authors.initials: M
authors.lastname: Miyazaki
mesh_terms: D001652:Bile Ducts / Q000002:abnormalities; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D020347:Lithiasis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008107:Liver Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011169:Portal Vein / Q000002:abnormalities; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*