Right Hepatectomy In Patient with Absent Portal Vein Bifurcation

Craig Kornbau,Andrei Cocieru,Mohammed Festok

doi:10.31487/j.ijscr.2019.02.01

Abstract

Introduction: Understanding of hepatic vascular anatomy and its variations are crucial for performing liver resection and transplantation. Here we present a case of successful right hepatectomy in the patient with absent portal vein bifurcation. Case presentation: 34 years old female presented for elective right hepatectomy. Preoperative CT scan demonstrated absence of portal vein bifurcation. Right hepatectomy was safely achieved by parenchymal division under ultrasound guidance with preservation of intrahepatic portal branches to left hemiliver and without postoperative complications. Discussion: Normal portal vein anatomy is observed in 65-86% of all cases [1, 2]. Of all portal vein anatomy variations, absence of the portal vein bifurcation is rarest among reported with incidence as low as 0.03% [1]. Conclusion: Preoperative recognition of aberrant portal vein anatomy is important for prevention of life-threatening complications after elective hepatectomy and transplantation.

Highlights

Understanding of hepatic vascular anatomy and its variations are crucial for performing liver resection and transplantation
We present a case of successful right hepatectomy in the patient with absent portal vein bifurcation
Normal portal vein anatomy is observed in 65-86% of all cases [1, 2]

Summary

Introduction

We present a case of preoperative recognition of rare portal vein anatomy and subsequent uncomplicated right hepatectomy in patient with absent portal vein bifurcation. 34 years old female with history of oral contraceptive use and large uterine fibroid presented with 12 cm biopsy proven hepatic adenoma. She was scheduled for elective right hepatectomy. On preoperative CT scan a rare variant of portal anatomy-absence of portal vein bifurcation was noted (Figures 1-2). Patient had single right portal vein entering the liver with intrahepatic branching to left portal vein. Origin of intrahepatic left portal vein branch was mapped under ultrasound control and preserved during resection.

Discussion

Ethical approval