Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jul 27, 2018; 10(7): 523-529
Published online Jul 27, 2018. doi: 10.4254/wjh.v10.i7.523
Hepatectomy for gallbladder-cancer with unclassified anomaly of right-sided ligamentum teres: A case report and review of the literature
Toru Goto, Hiroaki Terajima, Takehito Yamamoto, Yoichiro Uchida
Toru Goto, Hiroaki Terajima, Takehito Yamamoto, Yoichiro Uchida, Department of Gastroenterological Surgery and Oncology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka 530-8480, Japan
Author contributions: Goto T, Terajima H and Uchida Y managed the patient and performed the operation; Goto T collected the clinical data, designed this report and wrote the paper; Terajima H and Yamamoto T helped draft and revise the manuscript.
Informed consent statement: The patient provided informed written consent for publication of this case report.
Conflict-of-interest statement: The authors declare that no conflicts of interest are associated with this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Hiroaki Terajima, MD, PhD, Chief Doctor, Surgeon, Chief Director, Department of Gastroenterological Surgery and Oncology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, 2-4-20 Ohgimachi, Kita-ku, Osaka 530-8480, Japan.
Telephone: +81-6-63128824 Fax: +81-6-63128867
Received: February 19, 2018
Peer-review started: February 19, 2018
First decision: March 2, 2018
Revised: March 27, 2018
Accepted: May 30, 2018
Article in press: May 30, 2018
Published online: July 27, 2018
Case characteristics

A healthy and asymptomatic male in his 70s was incidentally diagnosed with a gallbladder tumor by preoperative computed tomography (CT) scanning for an inguinal hernia.

Clinical diagnosis

The patient, who had right-sided ligamentum teres (RSLT) with abnormal vascular anomaly, was diagnosed with advanced gallbladder cancer invading the right hepatic duct (RHD, cStage III A, T3; right bile duct, N0, M0).

Differential diagnosis

Based on 2 important findings, including a solid tumor-like appearance of the highly atrophied gallbladder by CT scanning and cytological evidence of adenocarcinoma from bile obtained by endoscopic retrograde gallbladder drainage rather than endoscopic nasobiliary drainage, advanced gallbladder cancer with infiltration of the RHD was more convincing than hilar cholangiocarcinoma as a preoperative diagnosis.

Laboratory diagnosis

Laboratory tests revealed that tumor markers and liver function were within the normal ranges.

Imaging diagnosis

Preoperative three-dimensional liver simulation based on multiple detector computed tomography scanning combined with endoscopic nasobiliary tube cholangiography revealed that all segmental portal veins were independently ramified from the portal trunk and that the RHD drained the right-sided liver except for segment 8 (segments 1r, 5, 6, and 7).

Pathological diagnosis

Pathological examination showed well-differentiated tubular adenocarcinoma of the gallbladder invading the hepatic parenchyma and the RHD.


The patient was treated with extended hepatectomy of the RHD drainage territory (segments 1r, 5, 6, and 7) without injuring the hepatic vasculature of the remnant liver based on preoperative liver simulation.

Related reports

Shindoh et al demonstrated anomalous vascular architecture with right-sided ligamentum teres (RSLT) and Ome et al reported major hepatectomy for RSLT patients. Shindoh J, Akahane M, Satou S, Aoki T, Beck Y, Hasegawa K, Sugawara Y, Ohtomo K, Kokudo N. Vascular architecture in anomalous right-sided ligamentum teres: Three-dimensional analyses in 35 patients. HPB (Oxford) 2012; 14: 32-41 [PMID: 22151449 DOI: 10.1111/j.1477-2574.2011.00398.x]. Ome Y, Kawamoto K, Park TB, Ito T. Major hepatectomy using the glissonean approach in cases of right umbilical portion. World J Hepatol 2016; 8: 1535-1540 [PMID: 28008345 DOI: 10.4254/wjh.v8.i34.1535].

Term explanation

RSLT is a congenital anomaly in which the umbilical ligament on the left side atrophies, and it is associated with anomalous ramifications in the artery, portal vein, and biliary systems.

Experiences and lessons

Preoperative 3D liver simulation based on precise intrahepatic vascular and biliary analysis enabled accurate and oncologically curative hepatic resection, even in a patient with rare anatomical anomalies.