A Case of Hepatocellurer Carcinoma Localized to the Caudate Lobe Accompanied by Repeated Hemobilia

Takaaki Sugimoto, Junichi Yamanaka, Tomohiro Okamoto, Keiji Nakashou¹⁾, Daisuke Joh²⁾ and Jiro Fujimoto

Department of Surgery and Department of Pathology¹⁾, Hyogo College of Medicine
Department of Surgery, Gokeikai Ikedakaisei Hospital²⁾

A 55-year-old man who had undergone transarterial embolization (TAE) elsewhere for hepatocellular carcinoma (HCC) evidenced by a S1 liver lesion (2 cm in diameter) in May 2004 was seen for right hypochondrial pain in August 2005. Abdominal computed tomography (CT) showed a hematoma of the gallbladder, diagnosed as acute hemorrhagic cholecystitis requiring cholecystectomy. Clots had accumulated of clots in the gallbladder and the mucosa was mildly inflamed. He suffered back pain, melena, and jaundice in November 2005, and endoscopic retrograde cholangiopancreatography (ERCP) showed hemobilia. Abdominal contrast CT showed a mass (3 cm in diameter) having ill-defined border in the caudate lobe. Based on HCC recurrence suspected, we conducted intraoperative cholangioscopy used for hemobilia and observed a tumor embolus proceeding from the bile duct branch of Spiegel's lobe into the left branch of the intrahepatic bile duct. Based on a diagnosis of HCC invasion to the bile duct, we totally resected the left hepatic and caudate lobes. Although few cases develop hemobilia due to HCC invasion to the bile duct, this should be considered in HCC follow-up.

Key words
HCC, biliary invasion, hemobilia

Reprint requests
Takaaki Sugimoto Department of Surgery, Hyogo College of Medicine
1-1 Mukogawacho, Nishinomiya, 663-8501 JAPAN

Accepted
February 17, 2010

To read the PDF file you will need Abobe Reader installed on your computer.