A Case of Congenital Biliary Dilatation with
Cavernous Transformation of the Portal Vein

Katsushi Yoshida, Yoshichika Okamoto, Takehito Katoh, Haruhiko Chigira, Yoshihisa Shibata, Shigemi Onoue, Minoru Esaki, Masayuki Sano, Masahide Fukaya and Matsuyoshi Maeda^*

Department of Surgery and Pathology^*, Toyohashi Municipal Hospital

A 40-year-old female complained of right upper quadrant pain. Clinical images revealed that the patient had congenital biliary dilatation (CBD) of Alonso-Lej's type I. Arterial portography showed cavernous transformation of the portal vein (CTPV). On March 1, 1995, resection of the dilatated bile duct and gallabladder with hepaticojejunostomy was performed. Because of difficulty in managing the bleeding from collateral portal veins, operative time was over 10 hours and operative blood loss was 5,615g. There was no significant change in the portal pressure before (15 cmH₂O) and after (16 cmH₂O) bile duct resection. Postoperative portograms disclosed that the cavernous transformation with hepatopetal collateral pathways was preserved. The patient is doing well 3 years and 10 months after operation. CBD with CTPV is a rare condition. Only three other cases are reported in the Japanese literature, and this is the first report of a patient undergoing resection of the bile duct. Operative indication and optimal procedure for this condition must be decided prudently. It should be noted that resection of the bile duct for CBD with CTPV is a high-risk operation for a benign disease, and may damage the portal collaterals that are essential for healthy hepatic function.

Key words
congenital biliary dilatation, cavernous transformation of the portal vein

Reprint requests
Katsushi Yoshida First Department of Surgery, Nagoya University School of Medicine 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 JAPAN

Accepted
March 31, 1999

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