cine MRI、経腹超音波による術前腸管癒着評価が役立った肝移植後の子宮内膜症性嚢胞の一例

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We present a case of a 19 year-old woman with endometriosis treated by laparoscopy 6 years after a liver transplant. This case had a high risk of visceral injury during trocar insertion. We used cine MRI for evaluation of intra-abdominal adhesions and color Doppler ultrasonography for detecting extrahepatic collateral routes. Previous major abdominal surgery has been considered a relative contraindication to laparoscopic surgery. Visceral injury during trocar insertion is comparatively frequent in laparoscopic surgery, especially for patients with a history of abdominal surgery. Functional cine MRI imaging has been reported to be a reliable noninvasive technique for detecting intra-abdominal adhesions. In this case, preoperative cine MRI findings showed no intra-abdominal adhesions between the small bowel and abdominal wall around the umbilicus. It is known that, after a liver transplant or its possible associated portal hypertension, there is a risk of recanalization by the umbilical and paraumbilical veins, which act as collaterals. We used cine MRI and Doppler ultrasound to evaluate this patient preoperatively for the presence of recanalization by these veins. We were able to perform laparoscopic surgery without complications with the use of preoperative cine MRI and Doppler ultrasound.