PMC10010588_01
Intraoperative finding showing intestinal non-rotation, with the large bowel- the descending colon, appendix on the left, and small bowel on the right side
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F1
The duodenojejunal (DJ) junction was found on the right side and the large bowel sited on the left in a position of complete non-rotation [Figure 1].
Intraoperative finding showing an atretic gallbladder (blue arrow)
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F2
Other intraoperative findings were a non-cirrhotic liver and an atretic extrahepatic biliary tract which included the gallbladder, common hepatic duct, the right and left hepatic ducts [Figure 2].
Intraoperative photographs showing accessory spleens (blue arrow) and spleen (white arrow)
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F3
Polysplenia consisting of four accessory spleens was noted in the left hypochondrium [Figure 3].
Intraoperative photograph after dissection of the porta hepatis, showing the right and left portal veins (blue arrow), and the fibrous cone transected at porta hepatis (white arrow)
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F4
For the latter, the entire extrahepatic biliary tree was mobilized right up to the porta hepatitis, with the proximal end of the tree culminating as a triangular fibrotic cone and excised flush to the liver substance [Figure 4].
Intraoperative photograph showing portoenterostomy: (A) placement of posterior wall sutures of the Roux-en-Y jejunal loop, (B) after completion of end-to-side portojejunostomy, and (C) after completion of end-to-side jejuno-jejunostomy
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F5
Bile drainage was restored by sewing this portion of the roux-en-Y loop to the plate with interrupted 5/0 vicryl sutures [Figure 5].