Ishii H, Sonoyama T, Nakashima S, Nagata H, Shiozaki A, Kuriu Y, Ikoma H, Nakanishi M, Ichikawa D, Fujiwara H, Okamoto K, Ochiai T, Kokuba Y, Sakakura C, Otsuji E. Surgical treatment of hepatocellular carcinoma with severe intratumoral arterioportal shunt. World J Gastroenterol 2010; 16(25): 3211-3214 [PMID: 20593509 DOI: 10.3748/wjg.v16.i25.3211]
Corresponding Author of This Article
Hiromichi Ishii, MD, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji-Kawaramachi, Kamigyo-ku, Kyoto 602-8566, Japan. ishii0512h@yahoo.co.jp
Article-Type of This Article
Case Report
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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, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
Author contributions: All authors contributed equally to this work; Ishii H wrote the paper; Ishii H, Sonoyama T, Nakashima S, Nagata H, Ikoma H and Ochiai T performed the operation.
Correspondence to: Hiromichi Ishii, MD, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji-Kawaramachi, Kamigyo-ku, Kyoto 602-8566, Japan. ishii0512h@yahoo.co.jp
Telephone: +81-75-2515111 Fax: +81-75-2515522
Received: March 10, 2010 Revised: April 14, 2010 Accepted: April 21, 2010 Published online: July 7, 2010
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.
