Focal fatty change in the liver that developed after cholecystectomy

Figure 5 Schematic diagram showing the possible mechanism of the development of focal fatty change in segment IV in the present case. A: Before cholecystectomy. Insulin-rich flow from the head of the pancreas may be diluted by venous blood that does not contain insulin. S4 of the liver may be normal in appearance, slightly enhanced, or slightly fatty, depending on the amount of blood flow and insulin conveyed to S4; B: After cholecystectomy. Because there is no more diluting blood flow from the gallbladder, insulin-rich flow from the head of the pancreas may directly reach S4 of the liver, where intense focal fatty change may occur. S4: Segment IV; PDV: Pancreaticoduodenal vein; RGV: Right gastric vein.