Abstract
Focal nodular hyperplasia (FNH) is a relatively common benign liver tumor with rare indications to surgery. Early after pregnancy, a 35-year-old woman developed right upper quadrant abdominal pain with fever. A large abdominal mass was palpable. Abdominal CT scan showed a 18-cm FNH substituting all liver segments but S6 and S7, compressing middle and left hepatic vein near their origin, displacing and compressing right hepatic vein, with ascites. Surgery consisted of a left hepatectomy extended to S5–S8 and S1. Main technical challenge was the preservation of the right hepatic vein. Intermittent pedicle clamping was performed, associated with hepatic vascular exclusion with preservation of caval flow; total duration of ischemia was 210 min. The postoperative course was uneventful, except for a transient fall in prothrombin time, and the formation of a sub-diaphragmatic serous collection, which was percutaneously drained. The patient is well 25 months after the operation. To our knowledge, this is the second reported case requiring surgery for a FNH causing a Budd–Chiari syndrome. In these peculiar cases a cumbersome operation may be required, maximizing all precautions to perform a risk-free procedure.
References
Rangheard AS, Vilgrain V, Audet P, O’Toole D, Vullierme MP, Valla D, Belghiti J, Menu Y (2002) Focal nodular hyperplasia inducing hepatic vein obstruction. AJR Am J Roentgenol 179:759–762
Belghiti J, Vilgrain V, Paradis V (2007) Benign liver lesions. In: Blumgart LH, Belghiti J, Jarnagin WR, DeMatteo RP, Chapman WC, Büchler MW, Hann LE, D’Angelica M (eds) Surgery of the liver, biliary tract and pancreas, 4th edn. Saunders Elsevier, Philadelphia, pp 1131–1150
Cherqui D (2001) Les tumeurs bénignes du foie. J Chir (Paris) 138:19–26
Ercolani G, Grazi GL, Pinna AD (2010) Liver transplantation for benign hepatic tumors: a systematic review. Dig Surg 27:68–75
Arrivé L, Dahan H, Tubiana JM (1999) Hepatic vein obstruction in a case of focal nodular hyperplasia. AJR Am J Roentgenol 173:857
Papanikolaou V, Vrochides D, Margari P, Giakoustidis D, Antoniadis N, Tsinoglou K, Akriviadis E, Takoudas D (2009) Hepatic focal nodular hyperplasia: when a benign lesion becomes “malignant”. Report of a case. Hippokratia 13:114–115
Elias D, Lasser P, Debaene B, Doidy L, Billard V, Spencer A, Leclercq B (1995) Intermittent vascular exclusion of the liver (without vena cava clamping) during major hepatectomy. Br J Surg 82:1535–1539
Cherqui D, Malassagne B, Colau PI, Brunetti F, Rotman N, Fagniez PL (1999) Hepatic vascular exclusion with preservation of the caval flow for liver resection. Ann Surg 230:24–30
Giuliante F, Nuzzo G, Ardito F, Vellone M, De Cosmo G, Giovannini I (2008) Extraparenchymal control of hepatic veins during mesohepatectomy. J Am Coll Surg 206:496–502
Nuzzo G, Giuliante F, Giovannini I, Vellone M, De Cosmo G, Capelli G (2001) Liver resections with or without pedicle clamping. Am J Surg 181:238–246
Sakamoto Y, Makuuchi M, Takayama T, Minagawa M, Kita Y (1999) Pringle’s maneuver lasting 322 min. Hepatogastroenterology 46:457–458
Valla DC (2003) The diagnosis and management of the Budd–Chiari syndrome: consensus and controversies. Hepatology 38:793–803
Valla DC (2009) Primary Budd–Chiari syndrome. J Hepatol 50:195–203
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This work was supported by a contribution of the Catholic University and the Italian Ministry for University and Scientific Research (D.1 Funds).
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Giuliante, F., Ardito, F., Ranucci, G. et al. Giant focal nodular hyperplasia determining Budd–Chiari syndrome: an operative challenge requiring 210 min of liver ischemia. Updates Surg 63, 307–311 (2011). https://doi.org/10.1007/s13304-011-0105-4
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DOI: https://doi.org/10.1007/s13304-011-0105-4