Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Compressive stenosis of the left hepatic vein as a pathogenesis of postresectional liver failure: a case report. | Ninomiya and Ikeda Journal of Medical Case Reports 2010 4 163 http content 4 1 163 Ws CASE REPORTS CASE REPORT Open Access Co mpressive stenosis of the left hepatic vein as a pathogenesis of postresectional liver failure a case report Mizuki Ninomiya 1 2 and Tetsuo Ikeda1 Abstract Introduction Postresectional liver failure PLF is a devastating and fatal complication of major hepatic resection and we do not have a full understanding of the pathogenic mechanisms involved. No reliable treatment other than liver transplantation currently exists for PLF. Case presentation A 46-year-old Japanese man experienced PLF after an extended right hepatectomy for liver malignancy. Seven months after surgery the patient s Model for End-Stage Liver Disease MELD score had reached 23. Doppler ultrasound study and three-dimensional computed tomography images showed a stenosed left hepatic vein compressed by surrounding hypertrophied hepatic parenchyma. Transluminal balloon angioplasty and stent placement therapy were conducted eight months after surgery. The pressure gradient between the hepatic vein and right atrium decreased from 13 to 3 mmHg after stent placement. Thereafter the patient recovered. Conclusion Hepatic venous compression by surrounding hypertrophied hepatic parenchyma might at least in part be associated with the occurrence of PLF. Surgeons should bear this possibility in mind when confronted with cases of PLF as early diagnosis and stent placement improves patients chances of recovery. Introduction Hepatic resection is the preferred treatment for hepatic malignancies like hepatocellular carcinoma or colorectal liver metastases. Although major hepatic resection is now accomplished with mortality rates of less than 5 in high volume centers post-resectional liver failure PLF remains a potentially devastating complication and often proves fatal 1 . The risk of PLF increases as the amount of resected liver parenchyma .
