Document Detail

Extreme left hepatic lobar atrophy in a case with hilar cholangiocarcinoma.
MedLine Citation:
PMID:  12068319     Owner:  NLM     Status:  MEDLINE    
We describe an unusual case of extreme hepatic left lobar atrophy with hilar cholangiocarcinoma. A 67-year-old woman was referred to Nippon Medical School with obstructive jaundice. On admission, computed tomography revealed dilated intrahepatic bile ducts and a defect in the area drained by the left side of the middle hepatic vein. A Spiegel lobe was demonstrated, but the left lobe could not be detected to the left side of the gallbladder. Percutaneous transhepatic cholangiography was performed and demonstrated obstruction of the intrahepatic bile duct at the hepatic hilum. A drainage catheter was left in place. Angiography revealed that the left hepatic artery was present, but there was narrowing of the left portal vein. A diagnosis of agenesis of the left hepatic lobe with hilar cholangiocarcinoma was made. At surgery, the left lobe appeared extremely atrophic without atrophy of the Spiegel lobe. The right anterior branches of the hepatic artery and portal vein had been invaded by carcinoma, so a left trisegmentectomy was performed. Final pathology was advanced hilar cholangiocarcinoma with invasion of the hepatic parenchyma, portal vein, and nervous system. The left lobe was atrophic without hepatolithiasis. The left portal vein was narrow distal to the Spiegel branch. The serum total bilirubin concentration was elevated postoperatively, and the patient was treated for hepatic failure. The patient died of pneumonia without recurrence 7 months after surgery. This rare case of extreme hepatic left lobar atrophy with hilar cholangiocarcinoma was successfully treated by left trisegmentectomy. Preoperative portal embolization was unnecessary because the left lobe was already atrophic.
Hiroshi Yoshida; Masahiko Onda; Takashi Tajiri; Yasuhiro Mamada; Nobuhiko Taniai; Atsushi Hirakata; Youichi Kawano; Yoshiaki Mizuguchi; Ichiro Tahara; Moto Kashiwabara; Yoshinori Ishikawa; Manabu Watanabe; Koho Akimaru
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Journal of Nippon Medical School = Nippon Ika Daigaku zasshi     Volume:  69     ISSN:  1345-4676     ISO Abbreviation:  J Nippon Med Sch     Publication Date:  2002 Jun 
Date Detail:
Created Date:  2002-06-17     Completed Date:  2002-07-23     Revised Date:  2012-09-25    
Medline Journal Info:
Nlm Unique ID:  100935589     Medline TA:  J Nippon Med Sch     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  278-81     Citation Subset:  IM    
First Department of Surgery, Nippon Medical School, Japan.
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MeSH Terms
Atrophy / complications
Bile Duct Neoplasms / complications,  surgery*
Bile Ducts, Intrahepatic* / surgery
Cholangiocarcinoma / complications,  surgery*
Liver / pathology*

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