Open AccessSurgical treatment of hepatocellular carcinoma with severe intratumoral arterioportal shunt
Author(s) -
Hiromichi Ishii,
Teruhisa Sonoyama,
Shingo Nakashima,
Hiroyuki Nagata,
Atsushi Shiozaki,
Yoshiaki Kuriu,
Hisashi Ikoma,
Masayoshi Nakanishi,
Daisuke Ichikawa,
Hitoshi Fujiwara,
Kazuma Okamoto,
Toshiya Ochiai,
Yukihito Kokuba,
Chohei Sakakura,
Eigo Otsuji
Publication year - 2010
Publication title -
world journal of gastroenterology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.427
H-Index - 155
eISSN - 2219-2840
pISSN - 1007-9327
DOI - 10.3748/wjg.v16.i25.3211
Subject(s) - medicine , hepatocellular carcinoma , indocyanine green , esophageal varices , embolization , sclerotherapy , radiology , varices , gastric varices , ligation , portal hypertension , hepatectomy , surgery , cirrhosis , gastroenterology , resection
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.