Teratoma arising from hepato duodenal ligament in the newborn with transection of portal vein, hepatic artery and common bile duct: A surgical challenge

Abstract

A 7-day-old neonate presented with a large intra-abdominal mass adherent to the hilum of the liver encasing the portal triad. During excision, the portal vein, hepatic artery, and common bile duct were injured. The repair was done promptly and needed massive blood transfusion. Histopathology revealed immature teratoma Grade III. Survival in neonate following total transection of portal triad is rare and has not been reported.

Teratoma in the hepatoduodenal ligament

“…In our case, the radiological examinations predicted the site of origin of the teratoma as the gastrohepatic ligament; however, its exact relationship with the HDL was an intraoperative surprise. Our report is only the 16 th case of teratoma originating from the HDL in the English literature [ Table 1 ],[ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 ] and diagnostic difficulty has been reported in a few of these cases. Brown et al .…”

“…Portal vein injury and their subsequent repair have been described in two cases earlier. [ 8 11 ] In a recent report by Ravikumar et al .,[ 14 ] complete transection of the portal vein, hepatic artery, and common bile duct was described in a neonate. Ukiyama et al .…”

“…Histopathologically, the majority of the reported cases (11 of 15) were mature teratomas similar to our case. [ 2 4 5 6 7 8 9 10 11 13 ] Three cases were immature teratomas[ 1 12 14 ] while in another case, the histopathology finding was not reported. [ 3 ] Yolk sac elements were found in two cases, one in relation to a teratoma with immature elements,[ 1 ] and the other one associated with a mature teratoma.…”