Surgical treatment of hepatocellular carcinoma with severe intratumoral arterioportal shunt.
We report a case of hepatocellular carcinoma (HCC) that caused a severe arterioportal shunt (APS). A 49-year-old man was admitted to hospital due to esophagogastric variceal hemorrhage and HCC, and underwent endoscopic variceal ligation (EVL) and endoscopic injection sclerotherapy (EIS). He was then referred to our hospital. Abdominal computed tomography revealed a low-density lesion in the posterior segment of the liver and an intratumoral APS, which caused portal hypertension. Although the patient underwent EVL, EIS, Hassab's operation, and transcatheter arterial embolization for APS, he vomited blood due to rupture of esophagogastric varices. Right hepatectomy was performed for the treatment of HCC and APS, although the indocyanine green retention value at 15 min after intravenous injection was poor (30%). The patient's postoperative course was uneventful. Eventually, APS disappeared and the esophagogastric varices improved.
Ishii
Hiromichi
H
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji-Kawaramachi, Kamigyo-ku, Kyoto 602-8566, Japan. ishii0512h@yahoo.co.jp
Sonoyama
Teruhisa
T
Nakashima
Shingo
S
Nagata
Hiroyuki
H
Shiozaki
Atsushi
A
Kuriu
Yoshiaki
Y
Ikoma
Hisashi
H
Nakanishi
Masayoshi
M
Ichikawa
Daisuke
D
Fujiwara
Hitoshi
H
Okamoto
Kazuma
K
Ochiai
Toshiya
T
Kokuba
Yukihito
Y
Sakakura
Chohei
C
Otsuji
Eigo
E
D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D004932:Esophageal and Gastric Varices / Q000601:surgery*; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome