PubMed · 4166521
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W Hess. 1966. [Palliative preliminary operations for severe obstructive jaundice].. https://pubmed.ncbi.nlm.nih.gov/4166521/
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From May to September 1991, 49 patients were examined by ultrasound (Picker CS 9000, 3.5 MHz curved array transducer) before and 30 minutes after drinking 150 ml of water. The volume of the gallbladder decreased significantly from a mean of 23.4 ml to 20.1 ml (p = 0.04). No significant change was found either between the visualisation of the gallbladder and bileducts (0.20 > p > 0.10) or the visualisation of the pancreas (0.40 > p > 0.30). However in 10 patients with cholelithiasis, the calculi were only seen in eight patients after drinking water. Thus, it must still be recommended that patients neither eat nor drink for four hours prior to an ultrasound examination of the gallbladder.
The Couinaud technique of left hepatic lobectomy involves the isolation and division of portal vein, hepatic artery, and biliary tributaries as a unit within the liver parenchyma. It saves time and minimizes blood loss by virtue of the common investment of the portal structures in a thick connective tissue sheath. Right hepatic lobectomy can be performed in a similar manner based on the same assumption that the biliary and vascular tributaries maintain a constant anatomic relationship with one another. We describe a patient who underwent right hepatic lobectomy by the Couinaud technique who (in retrospect) had congenital absence of a left hepatic duct. Because small bile ducts from the left lobe drained into the right hepatic duct deep to the sight of resection, obstructive jaundice resulted postoperatively, necessitating orthotopic liver transplantation. Presently, the patient is doing well 1 year after transplantation. When the Couinaud technique is used in the setting of a biliary anatomic variant, the results can be disastrous. This case illustrates that the Couinaud technique is unsafe unless biliary anatomic variants are excluded prior to hepatic lobectomy.
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