Reconstruction of the middle hepatic vein tributary with resection of the middle hepatic vein trunk: report of a case.

A 62-year-old man underwent right hepatectomy with resection of the middle hepatic vein trunk for metastatic liver cancers. Serious congestion of the caudal area of segment 4 occurred just after dividing the middle hepatic vein trunk. The reconstruction of the venous tributary from the caudal area of segment 4 to the inferior vena cava was performed using a saphenous vein graft of 11 cm in length. The congestion of the corresponding area improved just after the accomplishment of reconstruction, and the patient's postoperative course was uneventful. Serious congestion of the remnant liver observed in this case would occur rarely in the usual setting, because the stagnant blood flows backward to the portal branches or the intrahepatic venous anastomoses. In this case, the middle hepatic artery had been occluded by a steel coil for the treatment. Consequently, the occlusion of the middle hepatic artery have resulted in the serious congestion, because the portal branches to the caudal area of segment 4 were inflow vessels, not outflow ones, after division of the middle hepatic vein trunk. This is the first report on serious congestion of the caudal area of segment 4 and reconstruction of the venous tributary.