PMC5023639_01
White arrow right portal branch, black arrow inferior vena cava, gray arrow hepatic shunt
40064_2016_3221_Fig1_HTML.jpg
PMC5023639_01_40064_2016_3221_Fig1_HTML.jpg
Fig1
This herniation led to torsion of the caval axis and occlusion of the right and middle hepatic veins with modification of liver outflow, thus creating a right to left hepatic vein shunt passing anteriorly to the umbilical recess (Fig. 1).
White arrow hepatic shunt, black arrow diaphragm, gray arrow round ligament
40064_2016_3221_Fig2_HTML.jpg
PMC5023639_01_40064_2016_3221_Fig2_HTML.jpg
Fig2
Exclusively the left lobe remained inside the abdominal cavity with traction of the hepatic hilum under the right diaphragm with the round and falciform ligament overlying the diaphragm sustaining the liver (Fig. 2).
White arrow ligament compressing the inferior vena cava, black arrow inferior vena cava above the liver
40064_2016_3221_Fig3_HTML.jpg
PMC5023639_01_40064_2016_3221_Fig3_HTML.jpg
Fig3
The liver was rotated in the abdominal cavity intraoperatively: this retraction revealed a ligament between the diaphragm and the liver determining compression of the inferior vena cava (Fig. 3).
White arrow hepatic veins and shunt in front of the round ligament blue arrow portal system
40064_2016_3221_Fig4_HTML.jpg
PMC5023639_01_40064_2016_3221_Fig4_HTML.jpg
Fig4
A shift of the liver outflow was seen with a natural by-pass inverting flow from the right and middle hepatic veins to a large accessory hepatic vein in the parenchymal bridge in front of the umbilical recess and then to the left hepatic vein (Fig. 4).