Maeda N, Horie Y, Shiota G, Suou T, Andachi H, Kawasaki H
Second Department of Internal Medicine, Tottori University Faculty of Medicine, Yonago, Japan.
Hepatogastroenterology. 1998 Jul-Aug;45(22):1100-3.
Agenesis or hypoplasia of the hepatic lobe and floating gallbladder are both rare. We report an extremely rare case of hypoplasia of the left hepatic lobe accompanied by floating gallbladder. The patient was a 71-year-old woman, with no past history of related symptoms, who was admitted for further evaluation of postprandial epigastralgia, nausea, and diarrhea. Laboratory data on admission showed chronic liver disease with positive anti-hepatitis C virus antibody. Abdominal ultrasonography and computed tomography revealed the absence of the left hepatic lobe and displacement of the gallbladder to the left. On endoscopic retrograde cholangiography, the cystic duct originated from the right side of the bile duct, but the gallbladder was displaced to the left. Poor yolk-induced gallbladder contraction suggested the existence of hypotonic biliary dyskinesia. Angiography demonstrated no middle or left hepatic arteries, indicating congenital hypoplasia of the left hepatic lobe. Open cholecystectomy was carried out, and a diagnosis of hypoplasia of the left hepatic lobe accompanied by floating gallbladder and chronic hepatitis was confirmed. We believe that this is the first reported case of a hypoplasia of the left hepatic lobe coexisting with floating gallbladder.
肝叶发育不全或发育不良以及游离胆囊均较为罕见。我们报告一例极为罕见的左肝叶发育不良伴游离胆囊病例。患者为一名71岁女性,既往无相关症状病史,因餐后上腹部疼痛、恶心及腹泻入院进一步评估。入院时实验室检查显示慢性肝病且抗丙型肝炎病毒抗体呈阳性。腹部超声和计算机断层扫描显示左肝叶缺如且胆囊向左移位。在内镜逆行胆管造影检查中,胆囊管起源于胆管右侧,但胆囊向左移位。胆囊收缩功能不良提示存在低张性胆道运动障碍。血管造影显示无肝中动脉或肝左动脉,提示左肝叶先天性发育不良。遂行开腹胆囊切除术,确诊为左肝叶发育不良伴游离胆囊及慢性肝炎。我们认为这是首例左肝叶发育不良与游离胆囊并存的报道病例。