Splenic Artery Embolization for Refractory Ascites Following Hepatectomy for Hepatocellular Carcinoma

Surgery (Resection/Liver transplant) remains the only curative modality for the treatment of hepatocellular carcinoma (HCC). Post hepatectomy liver failure is the Achilles heel of liver surgery. Management of refractory ascites (RA), following a major resection especially in cirrhotic patients presents a formidable clinical challenge as it is often resistant to conventional treatment modalities. A 72-year gentleman diagnosed with hepatocellular carcinoma in the right lobe of liver with future liver remanent of 45% underwent a right hepatectomy. Postoperatively, despite conservative management with diuretics and albumin he had significantly high drain output. On the 10th day, he underwent proximal splenic artery embolization following which there was a progressive reduction in ascites and drain output. He was discharged in stable condition on the 15th day. Histopathology confirmed moderately differentiated HCC with adjacent steatohepatitis. The patient wass stable and disease free at the 3-month follow-up. Splenic artery embolization offers a safe and minimally invasive technique for management of RA post hepatectomy. Further studies are needed to conclusively establish the safety and utility of this procedure.