伊藤 優子¹, 川崎 俊彦¹, 岩瀬 加代子¹, 西川 温博¹, 森安 史典²

Yuko ITOH¹, Toshihiko KAWASAKI¹, Kayoko IWASE¹, Haruhiro NISHIKAWA¹, Fuminori MORIYASU²

¹京都桂病院内科, ²京都大学医学部附属病院第1内科

¹Gastroenterology Division, Kyoto Katsura Hospital, ²The First Department of Medicine, Kyoto University School of Medicine

キーワード : Gastric cancer, Portal Venous thrombosis, Color Doppler ultrasonography

An autopsy case of gastric cancer leading to hepatic failure associated with massive portal thrombosis is reported. A 79-year-old male was admitted to our hospital for a follow up examination of anemia. An endoscopy revealed Borrmann 3 carcinoma in the stomach. The serum AFP level was 3702ng/dl. Abdominal ultrasonography, X-ray CT, and MRI revealed a thrombus in the portal trunk, splenic vein and superior mesenteric vein, and a cavernomatous transformation in the porta hepatis. The abdominal color Doppler ultrasongraphy showed that the portal trunk was completely obstructed by the massive tumor thrombus, and that there was no blood flow in the portal trunk. The abdominal color Doppler ultrasonography also showed hepatopetal flow from the cavernomatous transformation to the umbilical portion of the liver Therefore, we concluded that the cavernomatous transformation had prevented the passage of the blood from the portal circulation to the hepatocytes. The patient died as a consequence of hepatic failure four months later. Before his death, he suffered from massive ascites, which were transudate. Repeated cytology was negative. Therefore, we concluded that this ascites was due to portal hypertension. The autopsy revealed that the portal thrombus was distended to the peripheral branches of the intrahepatic portal vein. Therefore, we concluded that the decreased portal flow from the cavernomatous transformation had resulted in hepatic failure. Color Doppler ultrasonography is useful for diagnosing portal thrombosis and provides a great deal of information noninvasively.