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Case Reports
. 2010 Jul 7;16(25):3211-4.
doi: 10.3748/wjg.v16.i25.3211.

Surgical treatment of hepatocellular carcinoma with severe intratumoral arterioportal shunt

Hiromichi Ishii  1 , 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
Affiliations
Case Reports

Surgical treatment of hepatocellular carcinoma with severe intratumoral arterioportal shunt

Hiromichi Ishii et al. World J Gastroenterol. .

Abstract

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.

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Figures

Figure 1
Figure 1
Computed tomography examination. A: Low-density lesion in the posterior segment of the liver, which pressed the vena cava and right hepatic vein and opposed the right anterior superior portal vein; B: Hyper-enhanced portal vein during the arterial phase; C: Tumor thrombus in the posterior branch of the portal vein. A tumor opposed the right anterior inferior portal vein.
Figure 2
Figure 2
Upper gastrointestinal endoscopy revealing severe esophageal varices.
Figure 3
Figure 3
Arteriography. A: Right hepatic arteriography exhibiting the right portal vein, caused by severe intratumoral arterioportal shunt; B: Transarterial portography revealing non-enhancement of the portal vein because of portal hypertension.
See this image and copyright information in PMC

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