title: Remnant left lobe torsion causing hepatic venous outflow obstruction after hepatic right lobectomy for giant hepatocellular carcinoma: report of a case.
abstract: We report the case of a 67-year-old man with remnant left liver torsion causing acute hepatic venous outflow obstruction after right hepatectomy for giant hepatocellular carcinoma, which was successfully treated with surgery. After the primary surgery, he developed significant liver dysfunction and renal failure. Doppler ultrasonography disclosed gradual reduction of hepatic perfusion. Abdominal computed tomography revealed that the swollen remnant liver was dislocated in the right subphrenic space. After surgical repositioning of the left lobe into its anatomical position, the hepatic congestion immediately disappeared, and the hemodynamic parameters improved. The falciform and round ligaments were fixed to the anterior abdominal wall to keep the remnant liver in the anatomical position. His postoperative course was uneventful. Doppler ultrasonography was useful to assess hepatic perfusion for screening of acute hepatic venous outflow obstruction and abdominal computed tomography is definitive for diagnosis. Fixation of remnant liver may be effective for preventing hepatic venous outflow obstruction after right hepatectomy, particularly for giant tumor.
authors.affiliation: Department of Regenerative Surgery, Fukushima Medical University.
authors.forename: Naoya
authors.initials: N
authors.lastname: Sato
authors.forename: Akira
authors.initials: A
authors.lastname: Kenjo
authors.forename: Takao
authors.initials: T
authors.lastname: Tsuchiya
authors.forename: Takayuki
authors.initials: T
authors.lastname: Anazawa
authors.forename: Junichiro
authors.initials: J
authors.lastname: Haga
authors.forename: Tetsu
authors.initials: T
authors.lastname: Sato
authors.forename: Makoto
authors.initials: M
authors.lastname: Muto
authors.forename: Takashi
authors.initials: T
authors.lastname: Kimura
authors.forename: Mitsukazu
authors.initials: M
authors.lastname: Gotoh
mesh_terms: D000368:Aged; D006502:Budd-Chiari Syndrome / Q000000981:diagnostic imaging / Q000209:etiology*; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D006498:Hepatectomy / Q000009:adverse effects*; D006503:Hepatic Veins / Q000293:injuries / Q000601:surgery; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology*; D014057:Tomography, X-Ray Computed; D054159:Torsion, Mechanical