Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jul 27, 2018; 10(7): 523-529
Published online Jul 27, 2018. doi: 10.4254/wjh.v10.i7.523
Hepatectomy for gallbladder-cancer with unclassified anomaly of right-sided ligamentum teres: A case report and review of the literature
Toru Goto, Hiroaki Terajima, Takehito Yamamoto, Yoichiro Uchida
Toru Goto, Hiroaki Terajima, Takehito Yamamoto, Yoichiro Uchida, Department of Gastroenterological Surgery and Oncology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka 530-8480, Japan
Author contributions: Goto T, Terajima H and Uchida Y managed the patient and performed the operation; Goto T collected the clinical data, designed this report and wrote the paper; Terajima H and Yamamoto T helped draft and revise the manuscript.
Informed consent statement: The patient provided informed written consent for publication of this case report.
Conflict-of-interest statement: The authors declare that no conflicts of interest are associated with this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hiroaki Terajima, MD, PhD, Chief Doctor, Surgeon, Chief Director, Department of Gastroenterological Surgery and Oncology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, 2-4-20 Ohgimachi, Kita-ku, Osaka 530-8480, Japan. h-terashima@kitano-hp.or.jp
Telephone: +81-6-63128824 Fax: +81-6-63128867
Received: February 19, 2018
Peer-review started: February 19, 2018
First decision: March 2, 2018
Revised: March 27, 2018
Accepted: May 30, 2018
Article in press: May 30, 2018
Published online: July 27, 2018
Processing time: 158 Days and 7 Hours
Abstract

Right-sided ligamentum teres (RSLT) is a congenital anomaly in which the right umbilical ligament becomes dominant and anomalous ramifications of the hepatic vessels and biliary system are present. A male patient in his 70s was diagnosed with advanced gallbladder cancer directly infiltrating the right hepatic duct (RHD), together with RSLT. Preoperative three-dimensional simulation of the liver based on multiple detector computed tomography images after cholangiography revealed ramifications of all segmental portal veins from the portal trunk and discordance of the arterial and biliary branching patterns of segment 8. Fusion analysis of the biliary architecture and segmental volumetry showed that the RHD drained segments 1r, 5, 6, and 7. We successfully performed a modified right-sided hepatectomy sparing segment 8 (i.e., resection of the RHD drainage territory), with negative surgical margins. This report is the first to describe major hepatectomy for advanced gallbladder cancer with RSLT.

Keywords: Right-sided ligamentum teres; Hepatectomy; Gallbladder cancer; Preoperative liver simulation; Anomaly of the portal vein

Core tip: Right-sided ligamentum teres (RSLT) is a congenital anomaly that involves anomalous ramifications of the hepatic vessels and biliary system. A male in his 70s with RSLT was diagnosed with advanced gallbladder cancer directly infiltrating the right hepatic duct (RHD). Based on preoperative liver simulation, we successfully performed a modified right-sided hepatectomy sparing segment 8, which corresponded to resection of the RHD drainage territory (segments 1r, S5, S6, and S7), with negative surgical margins. This report is the first to describe major hepatectomy for advanced gallbladder cancer with RSLT.