CAVERNOUS TRANSFORMATION OF THE PORTAL-VEIN COINCIDING WITH EARLY GASTRIC-CANCER AND CHOLELITHIASIS

A 71-year-old man who developed jaundice with a high-grade fever was a dmitted to our hospital. The episode was ascribed to cholecysto-choled ocholithiasis. In the preoperative evaluation, a cavernous transformat ion of the portal vein and an early gastric cancer were found. The pat ient thereafter underwent an operation for those pathologies after the endoscopic removal of a choledochal stone; cholecystectomy, and a dis tal gastrectomy with regional lymph node dissection for gastric cancer . The proposed procedures of gastrectomy and cholecystectomy were comp leted without any major difficulty because no markedly enlarged collat eral veins were found in the area where the regional lymph node dissec tion was carried out. Thanks to advances in imaging modalities, an asy mptomatic cavernous transformation of the portal vein coinciding with gastric cancer such as that seen in the present case may be increasing ly encountered in the future. The greatest caution, however, needs to be exerted at operation to minimize any unexpected bleeding and to avo id any interruption of the porto-portal shunts in such cases. Further, the reestablishment of the portal blood supply to the liver might be required in advanced cases of gastric cancer, where regional lymph nod e dissection may necessitate skeletonization of the hepatoduodenal lig ament for curative purposes.