Abstract
A 37-year-old man on abdominal CT had a poorly enhanced and uncertain area at segment 2 of the liver with invasion to hilar portion. Abdominal angiography revealed irregular encasement at from proper hepatic artery to right hepatic artery and stiffness of the wall of the portal vein with obstruction of the left branch. Under the diagnosis of intrahepatic cholangiocarcinoma originated from segment 2 with invasion to hepato-duodenal ligament, extended left lobectomy including caudate lobe and complete en bloc resection of hepatoduodenal ligament was performed. Lymph node dissection was performed level 2 including lymph node along lesser curve of the stomach. After resection of artery and portal vein, arterioportal shunt (APS) was formed. Macroscopically, the tumor measured 5.2×3.2 cm in diameter invaded to hilar portion and caudate lobe. Cancer cell invaded to the inner wall of main route of the portal vein and to the surgical margin of the vessel at hepatic side. Moreover lymph node metastasis was recognized extremely including lymph node along lesser curve of the stomach. Because abdominal angiography at 16 days after the surgery revealed intrahepatic artery through the anastomosis from elevated jejunum, APS with patency was blocked. This case has now been followed for 1 year with no evidence of recurrence.
