World journal of gastroenterology · 2010
Surgical treatment of hepatocellular carcinoma with severe intratumoral arterioportal shunt.
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Ishii Hiromichi, Sonoyama Teruhisa, Nakashima Shingo, Nagata Hiroyuki, Shiozaki Atsushi, Kuriu Yoshiaki, Ikoma Hisashi, Nakanishi Masayoshi, Ichikawa Daisuke, Fujiwara Hitoshi, Okamoto Kazuma, Ochiai Toshiya, Kokuba Yukihito, Sakakura Chohei, Otsuji Eigo
Аннотация
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.