title: Giant focal nodular hyperplasia determining Budd-Chiari syndrome: an operative challenge requiring 210 min of liver ischemia.
abstract: Focal nodular hyperplasia (FNH) is a relatively common benign liver tumor with rare indications to surgery. Early after pregnancy, a 35-year-old woman developed right upper quadrant abdominal pain with fever. A large abdominal mass was palpable. Abdominal CT scan showed a 18-cm FNH substituting all liver segments but S6 and S7, compressing middle and left hepatic vein near their origin, displacing and compressing right hepatic vein, with ascites. Surgery consisted of a left hepatectomy extended to S5-S8 and S1. Main technical challenge was the preservation of the right hepatic vein. Intermittent pedicle clamping was performed, associated with hepatic vascular exclusion with preservation of caval flow; total duration of ischemia was 210 min. The postoperative course was uneventful, except for a transient fall in prothrombin time, and the formation of a sub-diaphragmatic serous collection, which was percutaneously drained. The patient is well 25 months after the operation. To our knowledge, this is the second reported case requiring surgery for a FNH causing a Budd-Chiari syndrome. In these peculiar cases a cumbersome operation may be required, maximizing all precautions to perform a risk-free procedure.
authors.affiliation: Hepatobiliary Surgery Unit, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Felice
authors.initials: F
authors.lastname: Giuliante
authors.forename: Francesco
authors.initials: F
authors.lastname: Ardito
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Ranucci
authors.forename: Ivo
authors.initials: I
authors.lastname: Giovannini
authors.forename: Gennaro
authors.initials: G
authors.lastname: Nuzzo
mesh_terms: D000328:Adult; D001803:Blood Transfusion; D006502:Budd-Chiari Syndrome / Q000209:etiology* / Q000601:surgery*; D003250:Constriction; D005260:Female; D020518:Focal Nodular Hyperplasia / Q000150:complications / Q000601:surgery*; D006498:Hepatectomy; D006801:Humans; D008099:Liver / Q000098:blood supply; D057725:Operative Blood Salvage; D052096:Warm Ischemia