Aberrant Hepatic Regeneration after Resection for Focal Nodular Hyperplasia Causing Pseudo-Obstruction

Abstract

Purpose: Focal nodular hyperplasia (FNH) is a benign liver lesion that may be incidentally found on imaging studies. Lesions are resected if they increase in size, exert mass effect on surrounding hepatic parenchyma/biliary tree, or cause symptoms. The surgical complications associated with resection of these benign lesions must be recognized. We describe a rare case of aberrant hepatic regeneration after resection for FNH. A 22 y/o white female on oral contraceptives presented with abdominal pain and nausea. A CT abdomen revealed an 8.5 cm right hepatic lobe mass consistent with FNH. Due to ongoing symptoms and compression of the biliary tree, a laparoscopic right lobectomy was performed. Subsequently, the patient had resolution of abdominal pain and nausea. Two months after the lobectomy, the patient noted intermittent right sided abdominal pain and nausea. An upper GI series with small bowel follow-through (SBFT) and CT were obtained (Figures 1, 2). SBFT and a coronal view of the CT scan revealed that the duodenum was in an abnormal position in the right upper quadrant (Figure 1). A transverse view of the same CT revealed hypertrophy of the liver to the left upper quadrant with confirmation of the duodenum in an abnormal right upper quadrant position (Figure 2). The patient's symptoms were attributed to abnormal location of the duodenum causing pseudo-obstruction. This was due to the potential space vacated by the right hepatic lobectomy with disproportionate regeneration of the left hepatic lobe to the left. The patient was supported with nutritional supplementation and watchful monitoring with an aggressive bowel regimen. There are no published cases that discuss abnormal hepatic regeneration after resection of FNH causing symptomatic pseudoobstruction. We must recognize the potential for abnormal hepatic regeneration as a cause for post-operative symptoms after resection for FNH.Figure 1: No Caption available.Figure 2: No Caption available.