Two Cases of Hepatic Alveolar Echinococcosis with Complete Obstruction of the Inferior Vena Cava

Masao Sunahara, Toshiya Kamiyama, Naoki Sato, Nobuaki Kurauchi, Toichi Ito, Hisashi Okubo, Tomoya Katayama, Michiaki Matsushita and Satoru Todo

First Department of Surgery, Hokkaido University School of Medicine

Hepatic alveolar echinococcosis, a parasitic disease, occasionally obstructs the inferior vena cava (IVC) if allowed to progress too far. We previously only drained the infected lesion in such cases. We report 2 cases of alveolar echinococcosis with obstruction of the retrohepatic IVC treated by hepatic resection with or without IVC resection. Case 1: A 71-year-old woman was admitted and diagnosed with hepatic alveolar echinococcosis occupying almost the entire liver, except for the left lateral segment, with obstruction of the retrohepatic IVC. She underwent right hepatic trisegmentectomy and resection of the obstructed suprarenal IVC, with the lesion completely successfully removed. The IVC was not reconstructed due to the presence of large collateral veins. She remains well for 2 years and 8 months since surgery under albendazole treatment. Case 2: A 37-year-old woman referred for alveolar echinococcosis in the left hepatic lobe with IVC obstruction and invasion near the right atrial orifice, underwent left hepatic lobectomy with venous bypass. Although we had planned to remove and reconstruct the IVC, we left the IVC in place with some residual lesion because the IVC and external right atrial wall were markedly affected by the disease. The patient remains well under albendazole treatment. An aggressive surgical approach is necessary in treating highly advanced alveolar echinococcosis to ensure a complete cure. Even in incomplete resection, reducing the lesion significantly improves the quality of life and prolongs survival under albendazole administration.

Key words
hepatic alveolar echinococcosis, inferior vena cava, hepatectomy

Reprint requests
Masao Sunahara First Department of Surgery, Hokkaido University School of Medicine
Kita-15 Nishi-7, Kita-ku, Sapporo, 060-8638 JAPAN

Accepted
September 24, 2003

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