A CASE OF RECURRENT HEPATOCELLULAR CARCINOMA AROUND A CELIOTOMY WOUND WITH INCISIONAL HERNIA

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We report a case of recurrent hepatocelular carcinoma (HCC) around a celiotomy wound with incisional hernia, together with a review of the literature. The case involved a 68-year-old man. There were previous histories of undergoing a nonshunting operation, partial hepatic resection (S3), and ethanol injection therapy (S7) for esophageal varices and a HCC with liver cirrhosis in November 1990. In August 1992, the microwave coagulonecrotic therapy under laparotomy was carried out for intrahepatic recurrence (S6). Fifteen months after the second operation he was readmitted to the hospital because of a tumor growth around the celiotomy wound and an elevation of α-fetoprotein. The tumor of the abdominal wall was extirpated. Histological examination revealed metastatic hepatocellular carcinoma (Edmondson classification III). In this case neither diagnostic nor therapeutic needle puncture has been performed. After the last operation, multiple lung metastasis, intracranial metastasis and recurrent abdominal tumor close to the excised site were recognized. It was thought that hematogenous metastasis was most probable for the abdominal tumor. On the other hand, a possibility of surgical transplantation was not ruled out because the metastatic tumor was located at the celiotomy scar with incisional hernia.
日本臨床外科学会の論文