外科ジャーナル

Laparoscopic Cholecystectomy in a Patient with Portal Cavernoma

Abstract

Nilanjan Panda, Ruchira Das, Subhoroto Das, Samik K Bandopadhyay, Dhiraj Barman and Ramakrishna Mondol

Portal cavernoma (network of collateral vessels around the portal vein) is found in one-third of patients with thrombotic portal vein. Management of Cholecystitis in such a patient is problematic. Laparoscopic cholecystectomy is usually contraindicated due to risk of haemorrhage.

A 32 year old female presented with symptomatic calculous cholecystitis and portal cavernoma without portal hypertension. Liver functions were normal (non-cirrhotic, no jaundice). Conservative treatment failed. Imaging assessment was by Ultrasound Doppler, followed by CT and MRCP, MRI and MRA.

We performed laparoscopic cholecystectomy was successfully performed. Operative time 210 minutes, blood loss 50 ml. Extreme caution and painstakingly meticulous dissection around the cavernoma was the key to success. Although open cholecystectomy may assume to be safer in such patients; enhanced magnified vision, access and maneuverability made laparoscopy a preferred option. Standby laparoscopic and open vascular instruments facility is essential.