Operation of hilar bile duct cancer with the constitutional indocyanine green excretory defect-report of a case

DOI 3 Citations 9 References
  • OTA Tetsuya
    Department of Cancer and Thoracic Surgery, Okayama University Postgraduate School of Medicine and Dentistry (Okayama)
  • HIRAI Ryuji
    Department of Surgery, Okayama Red Cross Hospital (Okayama)1
  • TSUKUDA Kazunori
    Department of Surgery, Okayama Red Cross Hospital (Okayama)1
  • MURAKAMI Masakazu
    Department of Surgery, Okayama Red Cross Hospital (Okayama)1
  • NAITOU Minoru
    Department of Surgery, Okayama Red Cross Hospital (Okayama)1
  • SHIMIZU Nobuyoshi
    Department of Cancer and Thoracic Surgery, Okayama University Postgraduate School of Medicine and Dentistry (Okayama)

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Other Title
  • 体質性ICG排泄異常症を伴った肝門部胆管癌の1手術例

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Abstract

We report a rare case of hilar bile duct cancer with constitutional ICG excretory defect, that revealed high retention of ICG test and normal retention of BSP test. The patient,60-year old man, was admitted with jaundice to our hospital. PTC and ERC showed the stenosis from hilar bile duct to right hepatic duct indicating hilar bile duct cancer. To reduce the total bililubin level, that was 12 mg/dl at admission, PTCD was performed into the hepatic bile duct of anterior and lateral segment. After the total bililubin level was normalized, ICG test, which was performed for the preoperative examination of hepatectomy routinely, revealed the markedly delay of ICG retention rate at 15 minutes (78%), while BSP retention rate at 30 and 45 minutes was the normal level (less than 1%). Since other liver function tests indicated no liver cirrhosis, we diagnosed this patient as constitutional ICG excretory defect and considered that the major hepatectomy may be feasible. Extended left hepatic lobectomy and hepatico-jejunostomy was performed and the post operative course was uneventful. Microscopic examination showed neither liver cirrhosis nor hepatitis, we supposed that the liver function of this case had been almost normal although the markedly delay of ICG retention rate. The constitutional ICG excretory defect was first reported by Namihisa et. al. in 1975, as a new type of dye excretory disorder of liver with heredity or construction. Our case is the first report of constitutional ICG excretory defect associated with hilar bile duct cancer that was required the major hepatectomy. In case of ICG excretory defect, the choice of adequate operation such as major hepatectomy is difficult, and more experience with this disorder might be required.

Journal

  • Tando

    Tando 16 (5), 392-396, 2002

    Japan Biliary Association

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