title: Hepatectomy in a hepatocellular carcinoma case with Dubin-Johnson syndrome and indocyanine green excretory defect.
abstract: A 77-year-old male patient with history of jaundice was referred to our hospital for treatment of hepatocellular carcinoma (HCC). He was found to have Dubin-Johnson syndrome (DJS), a clinical feature of constitutional jaundice with conjugated hyperbilirubinemia, and indocyanine green (ICG) excretory defect, both of which are rare conditions. Total bilirubin was 5.1 mg/dl and ICG retention at 15 min (ICGR15) (77.1 %). Converted ICGR15 from GSA scintigraphy was 15.9 %. Resection of the medial segment and ventral region of the anterior segment of the liver as well as cholecystectomy were performed. The background of the liver tissue was blackish yellow and consistent with DJS and chronic hepatitis. Although total bilirubin level increased to 8.2 mg/dl on the 2nd postoperative day, the patient ultimately recovered and he was discharged on the 14th day. His 1- and 2-year medical checkups indicated recurrence of HCC. He underwent transarterial chemoembolization and is presently doing well 39 months after surgery. We report here on evaluation and treatment of patients with such disorders.
authors.affiliation: National Hospital Iwakuni Clinical Center, Department of Surgery, 2-5-1 Kuroiso-machi, Iwakuni-shi, Yamaguchi, 740-8510, Japan. aoki@iwakuni-nh.go.jp.
authors.forename: Hideki
authors.initials: H
authors.lastname: Aoki
authors.affiliation: National Hospital Iwakuni Clinical Center, Department of Surgery, 2-5-1 Kuroiso-machi, Iwakuni-shi, Yamaguchi, 740-8510, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Morihiro
authors.affiliation: National Hospital Iwakuni Clinical Center, Department of Surgery, 2-5-1 Kuroiso-machi, Iwakuni-shi, Yamaguchi, 740-8510, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Arata
authors.affiliation: National Hospital Iwakuni Clinical Center, Department of Surgery, 2-5-1 Kuroiso-machi, Iwakuni-shi, Yamaguchi, 740-8510, Japan.
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Kanaya
authors.affiliation: National Hospital Iwakuni Clinical Center, Department of Surgery, 2-5-1 Kuroiso-machi, Iwakuni-shi, Yamaguchi, 740-8510, Japan.
authors.forename: Shou
authors.initials: S
authors.lastname: Takeda
authors.affiliation: National Hospital Iwakuni Clinical Center, Department of Surgery, 2-5-1 Kuroiso-machi, Iwakuni-shi, Yamaguchi, 740-8510, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Ninomiya
authors.affiliation: National Hospital Iwakuni Clinical Center, Department of Surgery, 2-5-1 Kuroiso-machi, Iwakuni-shi, Yamaguchi, 740-8510, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Seita
authors.affiliation: National Hospital Iwakuni Clinical Center, Department of Surgery, 2-5-1 Kuroiso-machi, Iwakuni-shi, Yamaguchi, 740-8510, Japan.
authors.forename: Kou
authors.initials: K
authors.lastname: Katsuda
authors.affiliation: National Hospital Iwakuni Clinical Center, Department of Surgery, 2-5-1 Kuroiso-machi, Iwakuni-shi, Yamaguchi, 740-8510, Japan.
authors.forename: Kohji
authors.initials: K
authors.lastname: Tanakaya
authors.affiliation: National Hospital Iwakuni Clinical Center, Department of Surgery, 2-5-1 Kuroiso-machi, Iwakuni-shi, Yamaguchi, 740-8510, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Takeuchi
keywords: Dubin–Johnson syndrome; GSA liver scintigraphy; Hepatocellular carcinoma; Indocyanine green excretory defect