ALPPS for hepatic mesenchymal hamartoma in an infant

Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS) has been recently introduced as a new procedure to improve the surgical management of large hepatic tumors with future liver remnant (FLR) less than 25% in adults. However, there's rare such case report of infants. We present a case of a 9-month-old infant with huge hepatic mesenchymal hamartoma who underwent ALPPS. The patient initially presented with one week history of abdominal distension and vomit after eating. Computed tomography(CT) showed a right hepatic lobe multilocular mass measuring 10 cm*9 cm*10 cm, occupying Ⅳ,Ⅴ,Ⅵ,Ⅶ,Ⅷ segment. Volumetric assessment of the FLR was 102.31 cm3, which is 22.74% of the estimated total liver volume. With considerably low FLR, we performed ALPPS procedure for the infant. The first stage of the procedure contained the ligation of the right branch of the portal vein and in-situ liver parenchyma split. The second stage entailing right trisectionectomy after 8 days. The success of this application proved that ALPPS is suitable for little infants with giant benign neoplasm. To our knowledge, this is the first successful case of infant's ALPPS.