title: Resection of an intra-operative ruptured hepatocellular carcinoma with continuous pringle maneuver and in situ hypothermic perfusion through the inferior mesenteric vein: a case report.
abstract: Intra-operative tumor rupture is a serious complication during resection of large hepatocellular carcinoma (HCC) leading to more blood loss. We report our experience in applying continuous Pringle maneuver with in situ hypothermic perfusion via inferior mesenteric vein catheterization to the portal vein of the remnant liver for resection during an extended left lobectomy of a large HCC which ruptured intraoperatively. Using this method, we successfully managed the patient without any further morbidity. This technique provides easier accessibility of in situ perfusion, decreases operative blood loss and prevents warm ischemic injury to the remnant liver during parenchymal transection. This method could be effective for the resection of large ruptured HCC.
authors.affiliation: Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Niao-Sung, Kaohsiung, Taiwan.
authors.forename: Yueh-Ming
authors.initials: YM
authors.lastname: Lin
authors.forename: Li-Wei
authors.initials: LW
authors.lastname: Chiang
authors.forename: Shih-Ho
authors.initials: SH
authors.lastname: Wang
authors.forename: Chih-Che
authors.initials: CC
authors.lastname: Lin
authors.forename: Chao-Long
authors.initials: CL
authors.lastname: Chen
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Millan
authors.forename: Chih-Chi
authors.initials: CC
authors.lastname: Wang
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D002404:Catheterization; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007036:Hypothermia, Induced; D007431:Intraoperative Complications; D008099:Liver / Q000293:injuries*; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008642:Mesenteric Veins / Q000601:surgery*; D010477:Perfusion; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D011379:Prognosis; D020127:Recovery of Function; D015427:Reperfusion Injury / Q000517:prevention & control; D012421:Rupture; D014656:Vascular Surgical Procedures