Abstract
A 54-year-old male patient with hepatocellular carcinoma of the right lobe underwent resection of the anterior area on July 31, 1984. In spite of a favorable postoperative course, the patient experienced initial hematemesis on September 26, 1985. The condition was diagnosed as hemorrhage from esophageal varices due to occlusion of the primary truncus of the portal vein on the basis of the results of angiography and esophageal endoscopy. Since hematemesis occurred again in December 13 of that year, an emergency operation involving anastomosis of the ileocolic vein and the inferior vena cava, splenectomy and posterior gastric vein ligation, was undertaken. One month after the operation, a continuous bruit was heard from the left epigastrium, which was diagnosed as a manifestation of splenic arteriovenous fistula by angiography. During observation of the course without treatment because of the patient's asymptomatic condition, exacerbation of the esophageal varices became gradually apparent, leading to the danger of hemorrhage. On April 20, 1987, therefore, splenic arteriovenous fistulectomy associated with resection of the pancreatic tail was undertaken, resulting in remission of the esophageal varices. There has been no recurrence of hepatocellular carcinoma in this patient. Eight case of postsplenectomy fistula of the splenic veins and arteries have been reported outside Japan, but this was considered to be the first case in Japan.
