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Ichikawa T, Matsumoto S, Nomura T, Yamamuro H, Tsuruya K, Kawaga T, Yamamoto S, Hashimoto J. A case of incomplete duplication of the portal vein associated with multiple congenital anomalies. Radiol Case Rep 2023; 18:2785-2789. [PMID: 37388262 PMCID: PMC10300478 DOI: 10.1016/j.radcr.2023.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 07/01/2023] Open
Abstract
Double portal veins are a duplication of the portal vein and normal portal vein with an accessory portal vein. We report a case of a 63-year-old asymptomatic female with double portal veins. There was fat accumulation observed in the area which was supplied by the first portal vein in normal position, and fatty sparing of the liver was observed in the area which was supplied by the second portal vein in the preduodenal position. The 2 portal veins were equal in size. Furthermore, the patient presented with multiple congenital anomalies, including double inferior vena cava, splenic lobulation, and accessory liver lobe. Therefore, double portal veins in our case were thought to be an incomplete duplication of the portal vein with multiple congenital anomalies.
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Affiliation(s)
- Tamaki Ichikawa
- Department of Radiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 159-1193, Japan
| | - Shunro Matsumoto
- Department of Radiology, Oita City Medical Association's Almeida Hospital, Oita, Japan
| | - Takakiyo Nomura
- Department of Radiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 159-1193, Japan
| | - Hiroshi Yamamuro
- Department of Radiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 159-1193, Japan
| | - Kota Tsuruya
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Tatehiro Kawaga
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Seiichiro Yamamoto
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Jun Hashimoto
- Department of Radiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 159-1193, Japan
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Inamoto S, Obama K, Asai S, Mizuno R, Itatani Y, Hashimoto K, Hisamori S, Tsunoda S, Hida K, Kawada K, Sakai Y. Laparoscopic distal gastrectomy for gastric cancer patient with intestinal malrotation: report of a case. Surg Case Rep 2019; 5:45. [PMID: 30911866 PMCID: PMC6433996 DOI: 10.1186/s40792-019-0606-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/15/2019] [Indexed: 12/18/2022] Open
Abstract
Background Intestinal malrotation, which arises from incomplete rotation of the embryonic midgut, is one of the congenital anomalies usually diagnosed in infancy. On the other hand, intestinal malrotation detected in asymptomatic adults is very rare. It is frequently diagnosed incidentally during abdominal surgery. We report a case of asymptomatic intestinal malrotation diagnosed during laparoscopic distal gastrectomy for gastric cancer. Case presentation A 59-year-old female was diagnosed with early-stage gastric cancer during health screening and admitted to our hospital for radical surgical treatment. Physical examinations and blood tests revealed nothing of note. The type 0-IIc gastric cancer was located in the posterior wall of the mid-body of the stomach. The histological type was poorly differentiated adenocarcinoma. Esophagogastroduodenoscopy and computed tomography (CT) suggested that the depth of tumor invasion was the submucosal layer without regional lymph node swelling. The clinical stage according to the TNM 7th edition was cT1b N0 M0, cStage I. Laparoscopic distal gastrectomy with D1+ lymph node dissection and Billroth-I method reconstruction was planned. During the infrapyloric lymph node dissection, a part of the pancreatic head showed unusual adherence to the first part of the duodenal wall. For safe and accurate lymphadenectomy while avoiding pancreatic injury, we deliberately focused on tracing the dissectible layer between the pancreatic parenchyma and fatty tissues including lymph nodes. Also, we changed the reconstruction procedure from Billroth-I to Roux-en-Y. After distal gastrostomy, we could not find the ligament of Treitz or jejunum on the left side below the transverse colon. Based on a review of the CT image, this patient was diagnosed with intestinal malrotation. Although the detection of malrotation during the operation was incidental, we could complete radical surgery and Roux-en-Y reconstruction safely. The type of malrotation was non-rotation (90°). She was discharged from our hospital without any complications. Conclusion We encountered a case of adult asymptomatic intestinal malrotation with gastric cancer. Even when encountering such a case during laparoscopic gastrectomy, reviewing CT images carefully to reconsider the anatomical anomalies, and tracing the dissectible layer accurately with adequate countertraction can facilitate safe and successful surgery.
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Affiliation(s)
- Susumu Inamoto
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kazutaka Obama
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Satsuki Asai
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Rei Mizuno
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoshiro Itatani
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kyoichi Hashimoto
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shigeo Hisamori
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shigeru Tsunoda
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Koya Hida
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kenji Kawada
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoshiharu Sakai
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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Variant arterial supply to the lesser curvature of the stomach and duodenum from double inferior phrenic arteries. Surg Radiol Anat 2014; 37:867-9. [PMID: 25380829 DOI: 10.1007/s00276-014-1392-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 11/03/2014] [Indexed: 10/24/2022]
Abstract
A rare case of the left accessory inferior phrenic artery (IPA) supplying the lesser curvature of the stomach and the right accessory IPA supplying the duodenum was observed during interventional radiography. To our knowledge, variation arteries supplying the stomach and duodenum have never been reported in English literature; herein, we report the first case of variant arterial supply to the lesser curvature of the stomach and duodenum from double IPAs.
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Matsuda M, Amemiya H, Hosomura N, Ogiku M, Fujii H. Hepatic resection for hepatocellular carcinoma in a patient with situs ambiguous with polysplenia: report of a case. Surg Today 2014; 45:765-71. [PMID: 25059348 DOI: 10.1007/s00595-014-0997-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 04/01/2014] [Indexed: 11/24/2022]
Abstract
We report a case of successful resection of hepatocellular carcinoma (HCC) in a patient with situs ambiguous with polysplenia (PS), a rare congenital anomaly. A 62-year-old Japanese man was admitted to our hospital for investigation and treatment of a hepatic tumor. Imaging studies revealed two HCCs, 2.5 and 0.7 cm in diameter, in the anterior section and segment 3 of the reversed liver, respectively. He also had multiple spleens in the right side of the abdomen, right side of the stomach, and duodenum, as well as azygous continuation of the inferior vena cava (IVC) with absence of the retro-hepatic IVC, a truncated pancreas, rare variation of the hepatic artery, and dextrocardia. We performed anterior sectionectomy of the liver and partial resection of segment 3. We found only two previous reports of HCC in patients with situs ambiguous with PS, but our patient is the first to have undergone anatomical hepatic resection of the reversed liver. Accurate anatomical assessment is essential during surgery on such patients.
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Affiliation(s)
- Masanori Matsuda
- First Department of Surgery, Yamanashi University School of Medicine, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan,
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G A L, Kagali NA, M S, Prasad BSS. Preduodenal portal vein in adult with polysplenia syndrome revisited with a case report. Indian J Surg 2014; 76:137-42. [PMID: 24891779 DOI: 10.1007/s12262-013-0812-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 01/07/2013] [Indexed: 11/26/2022] Open
Abstract
Preduodenal portal vein (PDPV) is a rare developmental anomaly. In infants, this is often associated with duodenal obstruction or biliary atresia. It is generally asymptomatic in adults (Ooshima et al., Hepato-Biliary-Pancreat Surg 5(4):455-458, 1998). Here, we report a singular case of adult PDPV that was discovered accidentally during emergency laparotomy for peritonitis due to gastric perforation in a 38-year-old lady. A plethora of congenital anomalies was uncovered, which is consistent with the reported cases of classical polysplenia syndrome, viz., multiple spleens of equal volume, visceral heterotaxia, right (Rt.)-sided stomach, a left (Lt.)-sided or a large midline liver, malrotation of intestine, a short pancreas, PDPV and IVC abnormalities (Gayer et al., Abdom Imaging 24:178-184, 1999). In addition, abnormalities like anamolous origin of Lt. gastric and splenic arteries from the abdominal aorta with absent celiac trunk, hepatic artery arising from the superior mesenteric artery, hepatic veins draining directly to Rt. atrium, etc. along with hypertrophic and lipomatous interatrial septum have also been detected during further investigations. As of now, we have come across 29 cases of adult PDPV reported in world literature and we are reporting our unique case with a review of literature on anomalies of visceral organs associated with PDPV.
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Affiliation(s)
- Latha G A
- Department of Surgery, ESICMH PGIMSR, Rajajinagar, Bangalore, India ; No. 281, 12th Main, NTI Layout, Vidyaranyapura, Bangalore, 560 097 India
| | - Nagaraj A Kagali
- Department of Surgery, ESICMH PGIMSR, Rajajinagar, Bangalore, India
| | - Shridhar M
- Department of Surgery, ESICMH PGIMSR, Rajajinagar, Bangalore, India
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Polysplenia syndrome: a review of the relationship with viscero-atrial situs and the spectrum of extra-cardiac anomalies. Surg Radiol Anat 2013; 35:647-53. [PMID: 23508931 DOI: 10.1007/s00276-013-1100-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 03/04/2013] [Indexed: 01/30/2023]
Abstract
Polysplenia syndrome is classified as one of the situs ambiguous or heterotaxy syndromes and is classically termed left isomerism or bilateral left-sidedness. However, polysplenia is a controversial and complex entity with no fixed pathognomonic features but rather a broad spectrum of abnormalities. In many published case series, polysplenia was neither associated with viscero-atrial heterotaxy nor with duplication of left-sided structures. The relationship between polysplenia and viscero-atrial situs is not clear. Several recent case reports describe the association of polysplenia with situs inversus totalis or with pancreatic; venous and other anomalies or with several types of malignancy. This article provides the reader with a review of the literature as well as our own experience aiming at better understanding of the polysplenia syndrome, its relationship with viscero-atrial situs and the spectrum of associated extra-cardiac anomalies.
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