Journal of Nippon Medical School: Vol.69 No.3 page.278

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ArticleTitle Extreme Left Hepatic Lobar Atrophy in a Case with Hilar Cholangiocarcinoma

AuthorList 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

Affiliation First Department of Surgery, Nippon Medical School

Language EN

Volume 69

Issue 3

Year 2002

Page 278-281

Received December 14, 2001

Accepted December 28, 2001

Keywords cholangiocarcinoma, hepatic lobar atrophy, trisegmentectomy

Abstract
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.

Correspondence to Hiroshi Yoshida, MD, First Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
hiroshiy@nms.ac.jp

ArticleTitle	Extreme Left Hepatic Lobar Atrophy in a Case with Hilar Cholangiocarcinoma
AuthorList	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
Affiliation	First Department of Surgery, Nippon Medical School
Language	EN
Volume	69
Issue	3
Year	2002
Page	278-281
Received	December 14, 2001
Accepted	December 28, 2001
Keywords	cholangiocarcinoma, hepatic lobar atrophy, trisegmentectomy
Abstract	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.
Correspondence to	Hiroshi Yoshida, MD, First Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan hiroshiy@nms.ac.jp