Mizuno Shugo, Iizawa Yusuke, Tanemura Akihiro, Kaluba Benson, Noguchi Daisuke, Ito Takahiro, Hayasaki Aoi, Fujii Takehiro, Murata Yasuhiro, Kuriyama Naohisa, Kishiwada Masashi
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
Surg Case Rep. 2024 Jun 11;10(1):140. doi: 10.1186/s40792-024-01945-3.
Absence of portal bifurcation is an extremely rare anomaly that should be recognized preoperatively, especially prior to a major hepatectomy.
A 45-year-old woman presented with abdominal pain, and abdominal computed tomography (CT) revealed dilatation of both the common bile duct (CBD) and intrahepatic bile duct (IHBD). Endoscopic retrograde cholangiopancreatography (ERCP) showed CBD and IHBD stones (B2 and B4). The CBD stones were removed, but the IHBD stones could not be, yet there was no evidence of malignancy at the site of IHBD stenosis. Enhanced CT revealed a dilated IHBD, while three-dimensional CT images showed the left portal vein running through the ventral side of the middle hepatic vein, which was diagnosed as the absence of portal vein bifurcation (APB). Laparoscopic left hepatectomy was successfully performed using real-time indocyanine green (ICG) fluorescence imaging.
Surgeons should be aware of the possibility of APB, a rare portal vein anomaly, before performing major hepatectomy. Real-time ICG fluorescence imaging may be helpful to ensure the precise anatomy of the liver during laparoscopic surgery.
门静脉分支缺如是一种极其罕见的异常情况，应在术前，尤其是在进行大型肝切除术前予以识别。
一名45岁女性因腹痛就诊，腹部计算机断层扫描（CT）显示胆总管（CBD）和肝内胆管（IHBD）均扩张。内镜逆行胰胆管造影（ERCP）显示CBD和IHBD结石（B2和B4）。CBD结石已取出，但IHBD结石未能取出，且IHBD狭窄部位无恶性肿瘤迹象。增强CT显示IHBD扩张，而三维CT图像显示左门静脉穿过肝中静脉腹侧，诊断为门静脉分支缺如（APB）。使用实时吲哚菁绿（ICG）荧光成像成功实施了腹腔镜左肝切除术。
外科医生在进行大型肝切除术前应意识到APB这种罕见门静脉异常情况的可能性。实时ICG荧光成像可能有助于在腹腔镜手术期间确保肝脏的精确解剖。
