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Postgastrectomy Development or Accentuation of Focal Fatty Change in Segment IV of the Liver

Correlation With the Presence of Aberrant Venous Branches of the Parabiliary Venous Plexus

Yoshimitsu, Kengo, MD, PhD*; Irie, Hiroyuki, MD*; Kakihara, Daisuke, MD*; Tajima, Tsuyoshi, MD*; Asayama, Yoshiki, MD*; Hirakawa, Masakazu, MD*; Ishigami, Kousei, MD*; Noshiro, Hirokazu, MD; Kakeji, Yoshihiro, MD; Honda, Hiroshi, MD*

Journal of Clinical Gastroenterology: May-June 2007 - Volume 41 - Issue 5 - p 507-512
doi: 10.1097/01.mcg.0000225613.86846.cb
Liver, Pancreas and Biliary Tract: Clinical Research

Background Focal fatty change in segment IV (S4) of the liver is occasionally a diagnostic dilemma in the postoperative follow-up of gastric cancer patients.

Goal To determine whether development of focal fatty change in S4 is related to the presence of aberrant venous branches of the parabiliary venous plexus (PBP).

Study Two hundred seventy-six patients with gastrectomy who had been imaged by thin-slice preoperative computed tomography (CT) and at least one postoperative CT, and had no apparent liver masses were retrospectively analyzed. Preoperative CT were evaluated for the presence of aberrant venous branches of PBP entering S4. Serial postoperative CTs were evaluated for any interval change in the appearance of S4 of the liver.

Results There were 6 patients out of 276 (2%) in whom focal fatty liver developed or accentuated after the surgery. In 5 out of the 6, preoperative CT demonstrated aberrant branches of PBP; 3 of these were suggested to be aberrant right gastric veins, and the etiologies were not determined in 2. In 1 case, no definite aberrant vessel was seen. Aberrant vessels were found in none of the remaining 270 patients. The incidence of aberrant vessels was significantly higher in patients who developed postoperative radiologic change in S4 than in those who did not (P<0.0001).

Conclusions Development or accentuation of focal fatty liver in S4 of the liver was observed in 2% of postgastrectomy patients and was closely related to the presence of aberrant venous branches of PBP.

Departments of *Clinical Radiology

Surgical Oncology

Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi Higashi-ku, Fukuoka, 812-8582, Japan

Reprints: Kengo Yoshimitsu, MD, Department of Radiology, Kyushu University Hospital, 3-1-1, Maidashi Higashi-ku, Fukuoka, 812-8582, Japan (e-mail:

Received for publication March 29, 2006; accepted June 28, 2006

© 2007 Lippincott Williams & Wilkins, Inc.