Portal vein anomaly associated with deviation of the ligamentum teres to the right and malposition of the gallbladder

Abstract

Purpose: To develop a complete clinical picture of a portal vein anomaly associated with a rightward-deviated ligamentum teres.

Materials and methods: Three hundred twenty-seven consecutive living donor candidates for partial liver transplantation were evaluated for hepatic vascular abnormalities with computed tomography supplemented with intraoperative examinations. Special attention was given to the branching pattern of the portal system and the relative positions of the umbilical portion of the portal vein, the ligamentum teres, and the gallbladder.

Results: Four donor candidates (1.2%) had a portal vein anomaly associated with a rightward-deviated ligamentum teres. In all four, the umbilical portion of the portal vein (and hence the ligamentum teres) was abnormal, lying above the gallbladder bed and giving off major branches to the right anterior segment. If unrecognized, these might have been ligated, leading to major complications in the donors.

Conclusion: A portal vein anomaly associated with a rightward-deviated ligamentum teres is an important clinical entity that is not as rare as indicated in the literature. This anomaly should be kept in mind during preoperative examination of the liver.