Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Surgical and Radiologic Anatomy
Published in: Surgical and Radiologic Anatomy 5/2009

01-06-2009 | Anatomic Variations

Absence of bifurcation of the portal vein

Author: Eleazar Chaib

Published in: Surgical and Radiologic Anatomy | Issue 5/2009

Login to get access

Abstract

Background

Absence of the horizontal segment of the left portal vein (PV) or absence of bifurcation of the portal vein (ABPV) is extremely rare anomaly. The aim of this study was to study the extra-hepatic PV demonstrating the importance of its careful assessment for the purpose of split-liver transplantation.

Method

Human cadaver livers (n = 60) were obtained from routine autopsies. The cutting plane of the liver consisted of a longitudinal section made immediately on the left of the supra-hepatic inferior vena cava through the gallbladder bed preserving the arterial, portal and biliary branches in order to obtain two viable grafts (right lobe—segments V, VI, VII, and VIII and left lobe—segments II, III, and IV) as defined by the main portal scissure. The PV was dissected out and recorded for application of the liver splitting.

Results

The PV trunk has been divided into right and left branch in 50 (83.3%) cases. A trifurcation of the PV was found in 9 (15.2%) cases, 3 (5%) was a right anterior segmental PV arising from the left PV and 6 (10%) a right posterior segmental PV arising from the main PV. ABPV occurred in 1 (1.6%) case.

Conclusion

Absence of bifurcation of the portal vein is a rare anatomic variation, the surgeon must be cautious and aware of the existence of this exceptional PV anomaly either pre or intra-operatively for the purpose of hepatectomies or even split-liver transplantation.
Literature
1.
Asonuma K, Shapiro AM, Inomata Y, Uryuhara K, Uemoto S, tanaka K (1999) Living related liver transplantation from donors with the left-sided gallbladder/portal vein anomaly. Transplantation 68(10):1610–1612PubMedCrossRef
2.
Atri M, Bret PM, Fraser-Hill MA (1992) Intrahepatic portal venous variations: prevalence with US. Radiology 184:157–158PubMed
3.
Baba Y, Hokotate H, Nishi H, Inoue H, Nakajo M (2000) Intrahepatic portal venous variations: demonstration by helical CT during arterial portography. J Comput Assist Tomogr 24(5):802–808PubMedCrossRef
4.
Chaib E, Ribeiro MAF Jr, Saad WA (2005) Gama-Rodrigues. The main hepatic anatomic variations for the purpose of split-liver. Transplant Proc 37(2):1063–1066PubMedCrossRef
5.
Charny CK, Ling P, Bolet J, Blumgart LH (1997) Clinical observation: congenital absence of the left portal vein in a patient undergoing hepatic resection. HPB Surg 10:323–327PubMedCrossRef
6.
Chevallier P, Oddo F, Baldini E, Peten EP, Diaine B, Padovani B (2001) Agenesis of the horizontal segment of the left portal vein demonstrated by magnetic resonance imaging including phase-contrast magnetic resonance venography. Euro Radiol 10(2):2343–2345
7.
Cheynel N, Arnal E, Rat P, Benoit L, Trouilloud P, Favre JP (2001) Absence of the portal bifurcation at the hilum of the liver due to intrahepatic origin of the left branch of the portal vein. Surg Radiol Anat 23(5):355–357PubMedCrossRef
8.
Couinaud C (1957) Le foie: etudes anatomiques et chirurgicales. Masson , Paris, pp 74–75
9.
Couinaud C (1999) Liver anatomy: portal (and suprahepatic segmentation) or biliary segmentation. Dig Surg 16:459–467PubMedCrossRef
10.
Couinaud C (1957) The hepatic pedicle. I. The intrahepatic portal vein. In: Couinaud C (ed) The liver: anatomic and surgical studies. Masson, Paris, pp 71–118
11.
Elias H, Sherrick JC (1969) Development of the human liver. In: Morphology of the liver. Academic Press, New York, pp 233–261
12.
Elias H, Sherrick JC (1969) Development of the human liver. In: Gross anatomy of the liver. Academic Press, New York, pp 265–293
13.
Fraser-Hill MA, Atri M, Bret PM, Aldis AE, Illescas FF, Herschorn SD (1990) Intrahepatic portal venous system: bariations demonstrated with duplex and color Doppler US. Radiology 177:523–526PubMed
14.
Gallego C, Velasco M, Marcuello P, Tojedor D, de Campo L, Friera A (2002) Congenital and acquired anomalies of the portal venous system. Radiographics 22:141–159PubMed
15.
Hardy KJ, Nye DH (1969) An abnormal portal vein. Surgery 66:676–681PubMed
16.
17.
Koh MK, Ahmad H, Watanapa P, Jalleh RP, Habib NA (1994) Beware the anomalous portal vein. HPB Surg 7:237–240PubMedCrossRef
18.
Lerut J, Ciccarelli O, Danse E, Goffette P, Van Beers B, Reding R, Otte JB (2002) Left lobe living related liver transplantation in the absence of an extrahepatic left portal vein. Transplantation 74(2):278–279PubMedCrossRef
19.
McNulty JG, Khosa F (1999) Absence of bifurcation of the portal vein. Radiology 211(2):589–590PubMed
20.
Mitchell A, Mirza D, de Ville Goyet J, Buckels J (2000) Absence of the left portal vein: a difficulty for reduction of liver grafts? Transplantation 69(8):1731–1732PubMedCrossRef
21.
Rat P, Paris P, Favre JP (1992) One liver for two partition of the portal elements. World J Surg 16:1167–1171PubMedCrossRef
22.
Sato M, Ishida H, Konno K, Naganuma H, Komatsuda T, Hamashima Y, Watanabe S (2000) Congenital absence of the horizontal portion of the left portal vein: ultrasound findings. Euro Radiol 10(2):362–364CrossRef
23.
Soyer P, Bluemke DA, Choti MA (1995) Variation in the intrahepatic portions of the hepatic and portal veins: Findings on helical CT scans during arterial portography. Am J Roentgenol 164:103–108
24.
Yamamoto H, Nagino M, Kawabata Y, Maki A, Takenouchi Y, Iwahashi N, Hayakawa N, Nimura Y (2000) Resection of a hilar cholangiocarcinoma in a patient with absent portal bifurcation. Hepatogastroenterology 47(32):362–364PubMed
Metadata
Title
Absence of bifurcation of the portal vein
Author
Eleazar Chaib
Publication date
01-06-2009
Publisher
Springer-Verlag
Published in
Surgical and Radiologic Anatomy / Issue 5/2009
Print ISSN: 0930-1038
Electronic ISSN: 1279-8517
DOI
https://doi.org/10.1007/s00276-008-0413-7

Other articles of this Issue 5/2009

Surgical and Radiologic Anatomy 5/2009 Go to the issue

Original Article

Direct intrahepatic portocaval shunt through transhepatic puncture via retrohepatic inferior vena cava: applied anatomical study

Anatomic Variations

Double origin of the posterior inferior cerebellar artery with findings on conventional and CT angiography

Original Article

Peritoneal surface area: measurements of 40 structures covered by peritoneum: correlation between total peritoneal surface area and the surface calculated by formulas

Original Article

Postnatal changes in the styloid process, vagina processus styloidei, and stylomastoid foramen in relation to the function of muscles originating from the styloid process

Anatomic Bases of Medical, Radiological and Surgical Techniques

Percutaneous cervical disc decompression

Congress Announcement

Congresses