Intraoperative treatment by expandable metallic stent for the torsion of the portal vein after right hepatectomy

A 78-year-old man was referred to our hospital for further investigation of an 8.5-cm large mass in the right lobe of the liver. Abdominal dynamic CT revealed a tumor that was enhanced in the arterial phase and that showed lowdensity in the portal phase in the right liver. He was given a diagnosis of hepatocellular carcinoma and underwent right hepatectomy after percutaneous transhepatic portal vein embolization in the right branch of the portal vein. During surgery, the portal vein blood flow of the remnant liver was not confirmed by US after right hepatectomy. In intraoperative portal venography, only the portal vein of the caudate lobe could be observed. Therefore we diagnosed obstruction due to torsion of the left branch of the portal vein. Portal vein stent placement was performed during surgery. After stent placement, portal vein blood flow improved. Postoperatively, he received anticoagulation therapy and was discharged 23 days after surgery with good general condition. At present, 13 months after surgery, the portal vein blood flow is good and remains patent.