A Case Report of Proximal Bile Duct Cancer in Which Intraportal Endovascular Ultrasonography was Useful to Formulate the Operative Strategy

Tetsuya Kaneko, Akimasa Nakao, Soichiroh Inoue, Akio Harada, Toshiaki Nonami, Hiroshi Takagi

Department of Surgery II, Nagoya University School of Medicine

A 56-year-old woman was admitted to our hospital because of a proximal bile duct cancer. Percutaneous transhepatic cholangiography and percutaneous transhepatic cholangioscopy revealed that the cancer developed from the left hepatic duct to the common hepatic duct. Celiac angiography revealed no abnormal finding. Percutaneous transhepatic portography (PTP) revealed the obstruction of the left branch of the portal vein and slight stretch of the portal trunk. Following PTP, intraportal endovascular ultrasonography (IPEUS) was performed. The wall of the portal vein was visualized as an echogenic band with a thickness of 0.5 mm to 1.0 mm by IPEUS. The wall of the portal trunk was not destructed, so portal invasion of the tumor was diagnosed as negative. The finding of involvement of the right hepatic artery in the tumor was obtained by IPEUS. This finding was confirmed by the operation. Left hepatic lobectomy, caudate lobectomy and combined resection of the right hepatic artery was performed. Anastomosis between the proper hepatic artery and inferior mesenteric vein was performed in order to obtain partial arterialization of the portal vein. Leakage from the cholangiojejunostomy occurred after the operation, but resolved with conservative therapy. IPEUS was considered to be useful in making the accurate diagnosis of the portal vein and right hepatic arterial invasion of the tumor and in formulating the operative strategy.

Key words
proximal bile duct cancer, intraportal endovascular ultrasonography, partial arterialization of the portal vein

Reprint requests
Tetsuya Kaneko Department of Surgery II, Nagoya University School of Medicine
65 Tsurumai-cho, Showa-ku, Nagoya, 466 JAPAN

Accepted
September 8, 1993

To read the PDF file you will need Abobe Reader installed on your computer.