MAGNIFYING PERITONEOSCOPY COMBINED WITH INDOCYANINE GREEN STAINING METHOD IN A CASE OF FATTY LIVER

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A 34-year-old male admitted to the Toho University Hospital for the evaluation of liver dysfunction. He had no history of alcohol ingestion. His body weight was 55 kg and his height was 157.5 cm. On admission, the liver was palpable 3 cm below the right costal margin and biochemical data showed mild hepatocellular injury (GOT 42 units, GPT 85 units and γ-GTP 108 units). Latent diabetes mellitus was disclosed by glucose tolerance test. Since hepatic ultrasonography and CT strongly suggested the presence of fatty metamorphosis, especially located in the left liver lobe and the anterior area of the right liver lobe, peritoneoscopy was performed. The liver was swollen, and the surface was smooth and yellowish. Magnifying peritoneoscopy revealed so-called "leopard skin-like spotting". After indocyanine green (ICG) 200 mg was administered intravenously, the outline of hepatic lobules was accentuated and the areas of central vein were stained. Liver biopsy specimen revealed numerous deposits of large fat droplets, mainly distributed in the centrilobular and midzonal areas. The findings obtained by the magnifying peritoneoscopy combined with ICG staining method were well corresponded with such histological findings.
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