title: Relationship between midgut malrotation and anatomy of the hepatoduodenal ligament: a rare anatomical variation in a deceased donor.
abstract: BACKGROUND
  Anatomical variations around the hepatoduodenal ligament greatly influence surgical procedures and the difficulty of operations. Here, we report the case of a deceased donor with midgut malrotation (MgM) and anatomical variation. We also present an anatomical comparison between MgM and normal cases.
  
  
  METHODS
  The donor, a male in his 60s, was diagnosed with MgM based on preoperative computed tomography. Intraoperatively, the liver graft was harvested from the proper hepatic artery (PHA), but its length was too short for reconstruction. Therefore, the hepatic artery was reconstructed at both the left and right hepatic arteries.
  
  
  METHODS
  The length of the proper hepatic artery (l-PHA) and main trunk of the portal vein (l-PV) was compared between MgM and control groups (n = 9) using computed tomography. The ratio of PHA (r-PHA) and PV (r-PV), which was calculated as the l-PHA or l-PV divided by the patient's height, was also compared.
  
  
  RESULTS
  The r-PV was 1.3% in the MgM group and 1.6% in the control group (P = .09). The r-PHA was 0.23% in the MgM group and 0.92% in the control group (P < .01). Thus, the PHA was significantly shorter in the MgM group. Additionally, anatomical variations of the hepatic artery were confirmed in four cases.
  
  
  CONCLUSIONS
  Preoperative radiological evaluation is not always adequate for identifying anatomical abnormalities in deceased donors. MgM is a rare but important anomaly because of the possibility of associated anatomical variations of the hepatic artery.
authors.affiliation: Division of Cancer Medicine, Department of Gastroenterologic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan. Electronic address: pwrofdrms2000@staff.kanazawa-u.ac.jp.
authors.forename: H
authors.initials: H
authors.lastname: Hayashi
authors.affiliation: Division of Cancer Medicine, Department of Gastroenterologic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Takamura
authors.affiliation: Division of Cancer Medicine, Department of Gastroenterologic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Higashi
authors.affiliation: Division of Cancer Medicine, Department of Gastroenterologic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Shoji
authors.affiliation: Division of Cancer Medicine, Department of Gastroenterologic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors.forename: S-I
authors.initials: SI
authors.lastname: Nakanuma
authors.affiliation: Division of Cancer Medicine, Department of Gastroenterologic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Tajima
authors.affiliation: Division of Cancer Medicine, Department of Gastroenterologic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Kitagawa
authors.affiliation: Division of Cancer Medicine, Department of Gastroenterologic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Fushida
authors.affiliation: Division of Cardiovascular Medicine, Department of Radiology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Kosaka
authors.affiliation: Division of Environmental Science, Department of Gastroenterology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Kitahara
authors.affiliation: Division of Environmental Science, Department of Gastroenterology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Kakinoki
authors.affiliation: Department of Surgery, Public Central Hospital of Matto Ishikawa, Hakusan, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Tani
authors.affiliation: Division of Environmental Science, Department of Gastroenterology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Kaneko
authors.affiliation: Division of Cancer Medicine, Department of Gastroenterologic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Ohta
mesh_terms: D001926:Brain Death; D016022:Case-Control Studies; D004065:Digestive System Abnormalities / Q000150:complications* / Q000175:diagnosis; D006498:Hepatectomy; D006499:Hepatic Artery / Q000601:surgery; D006801:Humans; D008022:Ligaments / Q000002:abnormalities* / Q000000981:diagnostic imaging; D008099:Liver / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery; D019651:Plastic Surgery Procedures; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting / Q000379:methods; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome