There are three ways to approach and resect the
caudate lobe of the liver, that is; and isolated caudate
lobectomy, a combined resection of the liver overlying
the caudate lobe, and a transhepatic anterior
approach by splitting parenchyma of the liver.
We had two patients with neoplasms originating
in the caudate lobe who underwent a complete
caudate lobectomy. Both patients have been doing
well without liver dysfunction. Although after the
transhepatic anterior approach we anticipated an
adverse effect from splitting the parenchyma of the
liver, the postoperative course was uneventful and
similar to that of the right side approach.
Eight cases of hepatobiliary disease located adjacent to or within the perihepatic ligaments (peritoneal reflections surrounding the liver) with exophytic spread along these ligaments (three abscesses from cholecystitis, two bilomas, two hepatic abscesses, and one hematoma from a ruptured hepatocellular carcinoma, with 16 ligamentous lesions: five in the hepatoduodenal ligament, four in the ligamentum teres, three in the falciform ligament, two in the gastrohepatic ligament, one in the transverse mesocolon, and one in the duodenocolic ligament) were studied with sonography and computed tomography. The locations of underlying diseases were the inferior aspect of the left lobe of the liver (three patients), the gallbladder (three patients), and the right hepatic duct (two patients). An understanding of the anatomic detail of the ligamentous attachments of the liver and the continuity of peritoneal ligaments is important in recognizing the ligamentous spread of hepatobiliary disease. This mode of spread of disease should be kept in mind in diagnostic imaging of the abdomen.
The authors present a rare case of celiac artery aneurysm treated by aneurysmectomy and vascular reconstruction, and they review the past literature. A 57-year-old man was referred to their hospital with a complaint of epigastric discomfort. Abdominal echography, 3-dimensional computed tomography, and selective angiography showed a sole celiac artery aneurysm. At operation, the origin of the celiac artery and adjacent aorta was exposed through a midline transperitoneal approach alone. A 25 x 20 x 25 mm fusiform aneurysm of the celiac artery was found 5 mm distal from its origin. Aneurysmectomy and in situ aortoceliac artery reanastomosis was performed buttressed with a doughnut-shaped Teflon felt under the partial clamp of the abdominal aorta. The left gastric artery arising from the aneurysm was ligated. Postoperative angiography showed good patency of the splenic and common hepatic arteries. He had an uneventful postoperative course with no aggravation of the liver function and was discharged 11 days after operation. Pathological examination of the aneurysmal wall revealed medial degeneration with a tear of the internal elastic lamina and intimal edema. In situ aortoceliac artery reanastomosis after aneurysmectomy, as was done in this case, has not been previously documented in the past literature.
We report the unusual case of a 73-year-old man who underwent surgery for bilateral popliteal artery entrapment syndrome (PAES). A medial approach was used to operate on the left leg, and the vein bypass was made from the superficial femoral artery to the crural artery through a subfascial route. A posterior approach was used to operate on the right leg and it was found that the mid-popliteal artery passed medial to and beneath the medial head of the gastrocnemius muscle and was severely compressed by an accessory slip of muscle. The vein bypass from the above-knee to below-knee popliteal artery was established through the original route after resection of the accessory slip of muscle. A postoperative arteriogram showed good bypass flow to the bilateral crural arteries. To our knowledge, this case represents the oldest patient with this disorder to be treated by surgery.
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