Skip to main content

Advertisement

SpringerLink
Log in

Hepatic resection for hepatocellular carcinoma in a patient with situs ambiguous with polysplenia: report of a case

  • Case Report
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

We report a case of successful resection of hepatocellular carcinoma (HCC) in a patient with situs ambiguous with polysplenia (PS), a rare congenital anomaly. A 62-year-old Japanese man was admitted to our hospital for investigation and treatment of a hepatic tumor. Imaging studies revealed two HCCs, 2.5 and 0.7 cm in diameter, in the anterior section and segment 3 of the reversed liver, respectively. He also had multiple spleens in the right side of the abdomen, right side of the stomach, and duodenum, as well as azygous continuation of the inferior vena cava (IVC) with absence of the retro-hepatic IVC, a truncated pancreas, rare variation of the hepatic artery, and dextrocardia. We performed anterior sectionectomy of the liver and partial resection of segment 3. We found only two previous reports of HCC in patients with situs ambiguous with PS, but our patient is the first to have undergone anatomical hepatic resection of the reversed liver. Accurate anatomical assessment is essential during surgery on such patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. Applegate KE, Goske MJ, Pierce G, Murphy D. Situs revisited: imaging of the heterotaxy syndrome. Radiographics. 1999;19:837–52.

    Article  CAS  PubMed  Google Scholar 

  2. Fulcher AS, Turner MA. Abdominal manifestations of situs anomalies in adults. Radiographics. 2002;22:1439–56.

    Article  PubMed  Google Scholar 

  3. Ghosh S, Yarmish G, Godelman A, Haramati LB, Spindola-Franco H. Anomalies of visceroatrial situs. AJR Am J Roentgenol. 2009;193:1107–17.

    Article  PubMed  Google Scholar 

  4. Tawfik AM, Batouty NM, Zaky MM, Eladalany MA, Elmokadem AH. Polysplenia syndrome: a review of the relationship with viscero-atrial situs and the spectrum of extra-cardiac anomalies. Surg Radiol Anat. 2013;2013:19.

    Google Scholar 

  5. Sugimachi K, Ikeda Y, Taketomi A, Tomikawa M, Kawasaki K, Korenaga D, et al. Extended hemi-hepatectomy with portal vein reconstruction in a patient with situs ambiguous. Case Rep Gastroenterol. 2008;2:76–82.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Li T, Wang L, Chen RX, Ye QH, Sun HC, Qin LX, et al. Hepatocellular carcinoma with situs inversus totalis and polysplenia syndrome. Liver Int. 2007;27:1430–1.

    Article  PubMed  Google Scholar 

  7. Matsuda M, Fujii H, Kono H, Matsumoto Y. Surgical treatment of recurrent hepatocellular carcinoma based on the mode of recurrence: repeat hepatic resection or ablation are good choices for patients with recurrent multicentric cancer. J Hepatobiliary Pancreat Surg. 2001;8:353–9.

    Article  CAS  PubMed  Google Scholar 

  8. Low JP, Williams D, Chaganti JR. Polysplenia syndrome with agenesis of the dorsal pancreas and preduodenal portal vein presenting with obstructive jaundice—a case report and literature review. Br J Radiol. 2011;84:e217–20.

    Article  CAS  PubMed  Google Scholar 

  9. Peoples WM, Moller JH, Edwards JE. Polysplenia: a review of 146 cases. Pediatr Cardiol. 1983;4:129–37.

    Article  Google Scholar 

  10. Winer-Muram HT, Tonkin IL. The spectrum of heterotaxic syndromes. Radiol Clin North Am. 1989;27:1147–70.

    CAS  PubMed  Google Scholar 

  11. Matsusue S, Kashihara S, Koizumi S. Pancreatectomy for carcinoma of the head of the pancreas associated with multiple anomalies including the preduodenal portal vein. Jpn J Surg. 1984;14:394–8.

    Article  CAS  PubMed  Google Scholar 

  12. Hirohata S, Isobe H, Mitamura T, Yoshinoya S, Miyamoto T, Motoki T, et al. Situs ambiguous with polysplenia complicated by renal adenocarcinoma. Arch Intern Med. 1985;145:1134–7.

    Article  CAS  PubMed  Google Scholar 

  13. Curran JG, Ryan MJ. Hodgkin’s disease in a patient with polysplenia. Br J Radiol. 1987;60:929–31.

    Article  CAS  PubMed  Google Scholar 

  14. Iwamura T, Shibata N, Haraguchi Y, Hisashi Y, Nishikawa T, Yamada H, et al. Synchronous double cancer of the stomach and rectum with situs inversus totalis and polysplenia syndrome. J Clin Gastroenterol. 2001;33:148–53.

    Article  CAS  PubMed  Google Scholar 

  15. Chirica M, Vullierme MP, Sibert A, Cazals-Hatem D, Gaudin B, Belghiti J, et al. Major hepatectomy for peripheral papillary cholangiocarcinoma with hilar extension in a patient with situs ambiguous. Gastroenterol Clin Biol. 2005;29:456–60.

    Article  PubMed  Google Scholar 

  16. Park SS, Min BW, Kim WB, Han HJ, Yong HS, Kim SJ, et al. Double cancer of the stomach and oesophagus with situs ambiguus with polysplenia: the importance of preoperative evaluation. Dig Liver Dis. 2005;37:799–802.

    Article  PubMed  Google Scholar 

  17. Tsutsumi R, Nagata Y, Enjoji A, Ohno Y, Kamito H, Kanematsu T. Situs ambiguous with gastric cancer: report of a case. Surg Today. 2007;37:676–9.

    Article  PubMed  Google Scholar 

  18. Byun JR, Jahng JH, Song JC, Yu JS, Lee DK. Supine position endoscopic retrograde cholangiopancreatography in a patient with situs ambiguous with polysplenia. Dig Endosc. 2010;22:322–4.

    Article  PubMed  Google Scholar 

  19. Mimatsu K, Oida T, Kano H, Kawasaki A, Fukino N, Kida K, et al. Preduodenal portal vein, intestinal malrotation, polysplenia, and interruption of the inferior vena cava: a review of anatomical anomalies associated with gastric cancer. Surg Radiol Anat. 2012;34:179–86.

    Article  PubMed  Google Scholar 

  20. Choi MG, Kim JY, Noh JH, Bae JM, Kim S, Sohn TS. Laparoscopy-assisted distal gastrectomy in a patient with early gastric cancer and polysplenia. Surg Laparosc Endosc Percutan Tech. 2012;22:e15–7.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

Masanori Matsuda and his co-authors have no conflicts of interest to report.

Author information

Authors and Affiliations

  1. First Department of Surgery, Yamanashi University School of Medicine, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan

    Masanori Matsuda, Hidetake Amemiya, Naohiro Hosomura, Masahito Ogiku & Hideki Fujii

Authors
  1. Masanori Matsuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hidetake Amemiya
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Naohiro Hosomura
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Masahito Ogiku
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hideki Fujii
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masanori Matsuda.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Matsuda, M., Amemiya, H., Hosomura, N. et al. Hepatic resection for hepatocellular carcinoma in a patient with situs ambiguous with polysplenia: report of a case. Surg Today 45, 765–771 (2015). https://doi.org/10.1007/s00595-014-0997-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-014-0997-y

Keywords

Search

Navigation