[A Case in Which the ICG Fluorography Was Useful for Detecting Minute Peritoneal Disseminations]

Area of Science:

• Hepatobiliary surgery
• Surgical oncology
• Diagnostic imaging

Background:

• Hepatocellular carcinoma (HCC) is a primary liver malignancy.
• Ruptured HCC presents a surgical emergency with high risk of metastasis.
• Accurate detection of peritoneal dissemination is crucial for treatment planning.

Observation:

• A 65-year-old male presented with a ruptured 10 cm HCC.
• Initial treatments included transcatheter arterial embolization (TAE) and chemoembolization (TACE).
• Indocyanine green (ICG) fluorography during surgery identified four small omental nodules.

Findings:

• The ruptured HCC was resistant to TACE, necessitating left hepatectomy.
• Pathological examination confirmed the four omental nodules as peritoneal dissemination.
• ICG fluorography precisely localized these small metastatic nodules.

Implications:

• ICG fluorography offers enhanced visualization of peritoneal carcinomatosis.
• This technique can improve the detection rate of small metastatic nodules.
• Improved detection may lead to more tailored surgical and oncological management strategies.