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Case Reports
. 2012 Feb 13:10:34.
doi: 10.1186/1477-7819-10-34.

Surgical approach to multifocal hepatocellular carcinoma with portal vein thrombosis and arterioportal shunt leading to portal hypertension and bleeding: a case report

Francesca Ratti  1 , Federica Cipriani, Michele Paganelli, Gianfranco Ferla, Luca A M Aldrighetti
Affiliations
Case Reports

Surgical approach to multifocal hepatocellular carcinoma with portal vein thrombosis and arterioportal shunt leading to portal hypertension and bleeding: a case report

Francesca Ratti et al. World J Surg Oncol. .

Abstract

It is reported the case of a 69 years man who presented to the Emergency Room because of pain and abdominal distension from ascites. After admission and paracentesis placement, he developed a digestive hemorrhage due to oesophageal varices from portal ipertension secondary to the formation of a portal shunt concomitant with a multifocal HepatoCellular Carcinoma (HCC) with portal vein thrombosis (PVT). The patient underwent endoscopic varices ligation, twice transarterial embolization (TAE) of arterial branches feeding the shunt and subsequent left hepatectomy. During the postoperative course he developed mild and transient signs of liver failure and was discharged in postoperative day 16. He is alive and disease free 8 months after surgery.

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Figures

Figure 1
Figure 1
Confluent HCC lesions in the left lobe of liver.
Figure 2
Figure 2
Hyper-enhanced portal vein during the arterial phase.
Figure 3
Figure 3
Tumor thrombus in the left portal vein.
Figure 4
Figure 4
Preliminary angiography confirming APS presence.
Figure 5
Figure 5
APS embolization.
Figure 6
Figure 6
Persistent contrast enhancement of the portal vein.
Figure 7
Figure 7
APS refurnished from artery originating from the left gastric artery.
See this image and copyright information in PMC

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