Transplantation proceedings · 2020
Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy Tourniquet as a Resource for Hepatic Transplant in Patient With Hepatic Adenomatosis: A Case Report.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Ruiz Álvaro Jesús Gómez, López Víctor López, Campos Ricardo Robles, Conesa Asunción López, Brusadin Roberto, Martínez David Ferreras, Paricio Pascual Parrilla
Аннотация
BACKGROUND: Hepatic adenomatosis is defined as the presence of more than 10 adenomatous lesions seated on a healthy liver. The most frequent complication is bleeding, presenting a risk of malignant neoplasms of less than 10%.
CLINICAL CASE: We present a case of a 28-year-old woman with polycystic ovary syndrome treated with oral contraceptives for 10 years. Ultrasonography showed benign mass, and biopsy specimen showed adenoma. Nuclear magnetic resonance showed multiple hepatic adenomatosis with a large nodule in the right hepatic lobe of 21 cm and another 10 nodules in segments II, III, IVa, IVb, VIII-VII, and VI. A computed tomography scan with volumetry was performed where a future liver remnant volume (FLRV) of 30% was observed with an FLRV body weight ratio of 0.34%. Surgery was planned in 2 stages. First, the lesions of sections II-III, IVa, and IVb were resected and a ligature of right port vein and a tourniquet in Cantlie line were performed. At 15 days the computed tomography volumetry reported an FLRV of 48% with an FLRV body weight ratio of 0.55%. The second time was completed with a regulated right hepatectomy. The hospital stay was 5 days the first time and 6 days the second time, without complications. At present, the patient follows revisions in consultation without pathologic findings of interest.
CONCLUSION: In some extreme cases, surgical resection is limited by the FLRV and the risk of liver failure. Before considering liver transplant, associating liver partition and portal vein ligation for staged hepatectomy may be an effective alternative in the management of these patients.
CLINICAL CASE: We present a case of a 28-year-old woman with polycystic ovary syndrome treated with oral contraceptives for 10 years. Ultrasonography showed benign mass, and biopsy specimen showed adenoma. Nuclear magnetic resonance showed multiple hepatic adenomatosis with a large nodule in the right hepatic lobe of 21 cm and another 10 nodules in segments II, III, IVa, IVb, VIII-VII, and VI. A computed tomography scan with volumetry was performed where a future liver remnant volume (FLRV) of 30% was observed with an FLRV body weight ratio of 0.34%. Surgery was planned in 2 stages. First, the lesions of sections II-III, IVa, and IVb were resected and a ligature of right port vein and a tourniquet in Cantlie line were performed. At 15 days the computed tomography volumetry reported an FLRV of 48% with an FLRV body weight ratio of 0.55%. The second time was completed with a regulated right hepatectomy. The hospital stay was 5 days the first time and 6 days the second time, without complications. At present, the patient follows revisions in consultation without pathologic findings of interest.
CONCLUSION: In some extreme cases, surgical resection is limited by the FLRV and the risk of liver failure. Before considering liver transplant, associating liver partition and portal vein ligation for staged hepatectomy may be an effective alternative in the management of these patients.