回結腸静脈経由に右門脈血栓を除去し左肝切除術を施行しえた肝門部領域胆管癌肉腫の1例

Abstract

An 81-year-old man was referred to our hospital for hepatic dysfunction that was identified in an outpatient visit to another hospital. Abdominal contrast-enhanced CT revealed a tumor extending from the hepatic portal region to the left hepatic duct. Thus, the patient was diagnosed with hilar cholangiocarcinoma. Before surgery, EBD tube placement was performed because of obstructive jaundice. Subsequently, pancreatitis developed. CT revealed an inflammatory thrombus from the main trunk to the right branch of the portal vein. Thrombolytic therapy through the superior mesenteric artery was ineffective, with concurrent postoperative bleeding from the papilla. Four days after thrombus formation, catheterization was performed via the ileocolic vein under laparotomy for intraportal thrombus aspiration. Thirty days after the start of thrombosis treatment, left hepatectomy and bile duct resection were performed because portal vein blood flow resumed. The patient was diagnosed with carcinosarcoma. He has survived without recurrence for three years after surgery. We herein report this case of portal thrombosis in the remnant liver, for which radical surgery was performed postoperatively.