REMNANT LEFT LOBE TORSION CAUSING HEPATIC VENOUS OUTFLOW OBSTRUCTION AFTER HEPATIC RIGHT LOBECTOMY FOR GIANT HEPATOCELLULAR CARCINOMA: REPORT OF A CASE

NAOYA SATO; AKIRA KENJO; TAKAO TSUCHIYA; TAKAYUKI ANAZAWA; JUNICHIRO HAGA; TETSU SATO; MAKOTO MUTO; TAKASHI KIMURA; MITSUKAZU GOTOH

doi:10.5387/fms.2014-4

Case Report

REMNANT LEFT LOBE TORSION CAUSING HEPATIC VENOUS OUTFLOW OBSTRUCTION AFTER HEPATIC RIGHT LOBECTOMY FOR GIANT HEPATOCELLULAR CARCINOMA: REPORT OF A CASE

NAOYA SATO, AKIRA KENJO, TAKAO TSUCHIYA, TAKAYUKI ANAZAWA, JUNICHIRO HAGA, TETSU SATO, MAKOTO MUTO, TAKASHI KIMURA, MITSUKAZU GOTOH

Author information

NAOYA SATO
Department of Regenerative Surgery, Fukushima Medical University
AKIRA KENJO
Department of Regenerative Surgery, Fukushima Medical University
TAKAO TSUCHIYA
Department of Regenerative Surgery, Fukushima Medical University
TAKAYUKI ANAZAWA
Department of Regenerative Surgery, Fukushima Medical University
JUNICHIRO HAGA
Department of Regenerative Surgery, Fukushima Medical University
TETSU SATO
Department of Regenerative Surgery, Fukushima Medical University
MAKOTO MUTO
Department of Regenerative Surgery, Fukushima Medical University
TAKASHI KIMURA
Department of Regenerative Surgery, Fukushima Medical University
MITSUKAZU GOTOH
Department of Regenerative Surgery, Fukushima Medical University

Keywords: hepatic venous outflow obstruction (HVOO), right hepatectomy, giant liver tumor, torsion of the remnant liver

JOURNAL OPEN ACCESS FULL-TEXT HTML

2014 Volume 60 Issue 2 Pages 170-174

DOI https://doi.org/10.5387/fms.2014-4

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Abstract

We report the case of a 67-year-old man with remnant left liver torsion causing acute hepatic venous outflow obstruction after right hepatectomy for giant hepatocellular carcinoma, which was successfully treated with surgery. After the primary surgery, he developed significant liver dysfunction and renal failure. Doppler ultrasonography disclosed gradual reduction of hepatic perfusion. Abdominal computed tomography revealed that the swollen remnant liver was dislocated in the right subphrenic space. After surgical repositioning of the left lobe into its anatomical position, the hepatic congestion immediately disappeared, and the hemodynamic parameters improved. The falciform and round ligaments were fixed to the anterior abdominal wall to keep the remnant liver in the anatomical position. His postoperative course was uneventful. Doppler ultrasonography was useful to assess hepatic perfusion for screening of acute hepatic venous outflow obstruction and abdominal computed tomography is definitive for diagnosis. Fixation of remnant liver may be effective for preventing hepatic venous outflow obstruction after right hepatectomy, particularly for giant tumor.

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