Detection of perfusion areas of the gallbladder vein on computed tomography during arterial portography (CTAP) - The background for dual S-4a center dot S-5 hepatic subsegmentectomy in advanced gallbladder carcinoma

Background/Aims: It has been speculated that the veins of the gallbladder j oin the intrahepatic portal veins supplying the Couinaud's S-4a-S-5. This h as been the theoretical ground for the resection of these 2 hepatic subsegm ents in advanced gall-bladder carcinoma. However, no consensus has been rea ched on this concept. Methodology: The current study describes the non-neoplastic perfusion defec ts in connection with the gallbladder bed in 100 consecutive hepatic CTAP ( computed tomographies during arterial portography). The suitability of S-4a and S-5 subsegmentectomies of the liver for advanced gall-bladder carcinom a was also investigated by examining CTAP images of the branches of the por tal vein involved in the perfusion defect. Results: Two types of gallbladder venous perfusion were observed: 1) spheno id distribution from the gallbladder bed into the P-4a (37%), P-5 (52%) and P-6 (3%), and 2) perfusion into the P-4 (9%) or directly into the middle h epatic vein (9%) after communicating with the hepatic hilum at the dorsal s ide of S-4. Conclusions: These results support liver resection at S-4a and S-5 as the s urgical approach for cases of advanced gallbladder carcinoma.