Detection of the Left Portal Vein during Laparoscopic Distal Gastrectomy for Early Gastric Cancer—A Case Report—

Abstract

A 59-year-old woman was referred to our department for re-examination of abnormal findings of the stomach on a medical checkup. Upper gastrointestinal endoscopy revealed a type 0-IIc lesion, 30 mm in the longest diameter, in the middle third of the stomach. Poorly differentiated adenocarcinoma with signet ring cells was confirmed in biopsy specimens. We performed laparoscopic distal gastrectomy with D1 lymphadenectomy and gastroduodenostomy. During the surgery, we observed that the left portal vein, which was an aberrant left gastric vein, was transected endoscopically near the lateral segment of the liver with lymphadenectomy of the lesser coverture of the stomach. The patient's postoperative course was uneventful and he was discharged 13 days after the surgery. The presence of a left portal vein is a rare anomaly. Although we transected the left portal vein in order to accomplish systematic lymphadenectomy for gastric cancer treatment, there were no postoperative complications, including liver dysfunction. When we encounter a thick vein entering the liver during surgery, we may hesitate to transect it. With a recent increasing use of laparoscopic gastrectomy, our knowledge of the left portal vein is increasingly needed.