ArticleInternational journal of surgery case reports2025
Robotic segment III liver resection for hepatocellular carcinoma in the setting of Cruveilhier-Baumgarten syndrome: A case report.
Article in International journal of surgery case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Cruveilhier-Baumgarten syndrome (CBS) is a rare manifestation of portal hypertension characterized by recanalization of the umbilical vein in the setting of longstanding portal hypertension. Its occurrence in patients undergoing liver resection for hepatocellular carcinoma (HCC) is rarely reported. This report presents what appears to be the first documented case of HCC in the context of CBS treated by fully robotic segment III liver resection. Case presentation: We report the case of a 71-year-old female with a history of alcohol-related liver cirrhosis, classified as Child-Pugh C in 2015, who demonstrated remarkable clinical and biochemical recovery over the following decade. Imaging in 2025 revealed a 4 × 3.4 cm lesion in liver segment III, classified as Liver Imaging Reporting and Data System category 5 (LI-RADS 5) on gadoxetate disodium-enhanced magnetic resonance imaging (Gd-EOB-DTPA-enhanced MRI), and a markedly dilated recanalized umbilical vein, consistent with CBS. Preoperative alpha-fetoprotein (AFP) was elevated at 23.6 ng/ml and decreased to 4.6 ng/ml postoperatively. The patient underwent a robotic-assisted segment III liver resection using the Da Vinci Xi surgical system. Intraoperative findings confirmed both the HCC and a prominent umbilical vein within the falciform ligament. The procedure was completed without complications. Histopathology confirmed a moderately differentiated HCC with R0 resection margins. Discussion: This case demonstrates that robotic liver resection is feasible and safe despite the presence of extensive portosystemic collaterals, including a recanalized umbilical vein in the setting of longstanding portal hypertension. Robotic assistance allowed precise dissection in this complex vascular anatomy. The patient's transition from decompensated to compensated cirrhosis over a decade suggests that portosystemic shunting may have contributed to clinical stabilization. Importantly, the recanalization of the umbilical vein is not random but reflects an adaptive response to sustained portal hypertension. Conclusion: This case demonstrates that robotic liver resection can be a feasible and safe surgical option in selected cirrhotic patients with CBS, provided that individualized preoperative planning is undertaken. This case provides additional evidence for the feasibility of robotic liver resection in anatomically complex portal venous conditions.
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