A novel anatomic variation of the intrahepatic biliary tree in live liver donor surgery: A case report. (February 2021)

• Record Type: Journal Article
• Authors: Shizuku, Masato; Kurata, Nobuhiko; Jobara, Kanta; Yoshizawa, Atsushi; Ogura, Yasuhiro
• Is Part Of: International journal of surgery case reports. Volume 79(2021)
• Page Start: 231
• Page End: 233
• Publication Date: 2021-02
• Subjects: Novel anatomic variation of intrahepatic biliary tree -- Live-liver donor surgery -- The overlay visualization of magnetic resonance cholangiopancreatography and three-dimensional computed tomography -- Case report; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2021.01.042
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: We presented a novel anatomic variation of intrahepatic biliary tree, which had never been reported. The computerized overlay visualization of MRCP and 3-D CT helped biliary anatomical understanding for operation planning. Precise preoperative evaluation helped safe living donor surgery and living donor liver transplantation. Abstract: Introduction: Anatomic variations of the biliary tree are common, making precise anatomic evaluation important before hepatobiliary surgery. Presentation of case: A 52-year-old woman with no medical history was admitted to our hospital for a live-liver donation to her husband. During her evaluation, magnetic resonance cholangiopancreatography (MRCP) revealed a previously unknown anatomic variation in her biliary system. Segment 2 of the bile duct (B2) independently drained into the posterior branch and formed a common channel (B2+posterior) before joining the anterior branch. Then, bile duct segments 3 and 4 (B3+4) drained into this B2+posterior+anterior channel to form a common hepatic duct. The computerized overlay features shown by MRCP and three-dimensional computed tomography clarified this anatomic variation. A right lobe donor graft was then obtained successfully, with intraoperative cholangiography confirming that the donated graft had two bile duct orifices (i.e., posterior and anterior branches). We thus avoided surgical missteps that would have disallowed bile drainage of B2 and B3+4 into the common hepatic duct. Discussion: Precise evaluation is mandatory for hepatobiliary surgical planning to rule out, or discover, challenging bile duct anatomy. Conclusion: Preoperative computerized overlay visualization of MRCP and computed tomography allowed definition of a previously unknown biliary tree variation.