Abstract
BackgroundA right-sided ligamentum teres (RSLT) is a rare congenital anomaly in which the fetal umbilical vein is connected to the right paramedian trunk. RSLT creates difficulty in liver resection with respect to decision-making regarding the resection line, deviation of the vasculobiliary architecture. We report a case in which laparoscopic left lateral sectionectomy (LLLS) was performed to treat colorectal liver metastasis (CRLM) in a patient with RSLT.Case presentationA 63-year-old man with a past history of rectal cancer presented to our institution due to liver metastasis in the left lateral section from rectal cancer. In this patient, an RSLT was diagnosed and LLLS was planned. The lateral superior branch of the portal vein (P2) branched off behind the bifurcation of the portal vein and running separately from the common branch of the lateral inferior branch (P3) and left paramedian branch (P4) so that stapling could not be performed for liver resection. Frequent intraoperative ultrasonography (IOUS) was necessary to identify the root of P2 and P3. The resection line was distant from the falciform ligament and was carefully decided. The lateral superior branch of Glisson (G2) and lateral inferior branch of Glisson (G3) were separately resected. The patient had a favorable clinical course without any complications.ConclusionsThe resection line of LLLS, which is distant from the falciform ligament, should be carefully identified using IOUS due to the deviation of the umbilical portion and falciform ligament. The recognition of portal vein and hepatic vein anomalies and clear identification of the lateral sectional branches are important to complete LLLS in patients with an RSLT.
Highlights
ConclusionsThe resection line of left lateral sectionectomy (LLLS), which is distant from the falciform ligament, should be carefully identified using intraoperative ultrasonography (IOUS) due to the deviation of the umbilical portion and falciform ligament
A right-sided ligamentum teres (RSLT) is a rare congenital anomaly in which the fetal umbilical vein is connected to the right paramedian trunk
The resection line of left lateral sectionectomy (LLLS), which is distant from the falciform ligament, should be carefully identified using intraoperative ultrasonography (IOUS) due to the deviation of the umbilical portion and falciform ligament
Summary
In patients with an RSLT, the falciform ligament is not a landmark of the origins of the G2 and G3, which are buried in the liver and difficult to identify without IOUS. These two branches had to be separately resected. The recognition of the RSLT on preoperative imaging is important for avoiding the mistaken impression that the resection line should be along the falciform ligament
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