Zenda Takahiro, Araki Ichiro, Hamano Naomichi, Sawada Emi, Nakamiya Otoyuki, Endo Tamao, Nishida Hiroto, Ojima Eisuke, Nakano Tatsuo
Department of Internal Medicine, Asanogawa General Hospital, Kosaka-machi Naka 83, Kanazawa, 920-8621, Japan.
Department of Radiology, Asanogawa General Hospital, Kanazawa, Japan.
Clin J Gastroenterol. 2019 Oct;12(5):453-459. doi: 10.1007/s12328-019-00951-5. Epub 2019 Feb 22.
The effect of a prior defect on secondary liver atrophy is unknown. We describe a case of sigmoid volvulus that was facilitated by progressive atrophy in a deformed liver. A 75-year-old man with abdominal pain and fullness was referred to our hospital. Computed tomography (CT) revealed reduced left hepatic lobe volume and a whirl sign, characteristic of sigmoid volvulus. The sigmoid volvulus was successfully detorted with endoscopy. Retrospective evaluation of liver morphology on CT and magnetic resonance imaging showed that the portal vein at the liver hilum was denuded due to a parenchymal defect of the medial segment, with compression by the crossing artery. As pulse Doppler ultrasonography demonstrated reduced portal blood flow in the region where liver atrophy developed, compression of the denuded portal vein presumably facilitated secondary atrophy and contributed to sigmoid volvulus. The present case shows that a deformed liver itself can be a cause of secondary atrophy. Therefore, continued monitoring of liver morphology and evaluation of portal blood flow to predict liver atrophy may be required, when an individual with a partial liver defect is encountered.
既往肝脏缺陷对继发性肝萎缩的影响尚不清楚。我们描述了一例因变形肝脏的进行性萎缩而导致乙状结肠扭转的病例。一名75岁男性因腹痛和腹胀被转诊至我院。计算机断层扫描（CT）显示左肝叶体积减小及乙状结肠扭转的特征性漩涡征。乙状结肠扭转通过内镜成功复位。对CT和磁共振成像上肝脏形态的回顾性评估显示，肝门处的门静脉因内侧段实质缺损而裸露，并受到交叉动脉的压迫。由于脉冲多普勒超声显示肝萎缩区域的门静脉血流减少，裸露门静脉的受压可能促进了继发性萎缩并导致乙状结肠扭转。本病例表明，变形的肝脏本身可能是继发性萎缩的原因。因此，当遇到有部分肝脏缺陷的个体时，可能需要持续监测肝脏形态并评估门静脉血流以预测肝萎缩。
