International journal of surgery case reports · 2024
Treatment of intractable isolated bile leakage occurring after right anterior sectionectomy for hepatocellular carcinoma: Right hepatico-jejunostomy.
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Fujii Tomomasa, Onoe Takashi, Tanimine Naoki, Shimizu Yosuke, Tashiro Hirotaka
Аннотация
INTRODUCTION: An isolated bile leakage is a relatively rare type of postoperative bile leakage. Most isolated bile leakages require invasive procedures such as surgical approaches.
PRESENTATION OF CASES: The right hepatic duct was intraoperatively injured during right anterior sectionectomy. Bile leakage occurred postoperatively in the injured bile duct, although the injured bile duct was repaired with suturing and C-tube drainage was performed to decompress the bile duct during hepatectomy. Unfortunately, nonsurgical treatment was not possible. Therefore, bilio-enteric anastomosis between the right hepatic duct and jejunum was ultimately performed because of the small remnant liver volume and poor liver function.
DISCUSSION: Bilio-enteric anastomosis can avoid sacrificing functioning liver parenchyma, but in cases of hepatocellular carcinoma recurrence, transarterial chemoembolization carries a high risk of liver abscess due to cholangitis in patients undergoing enteric revision. Liver resection or bilio-enteric anastomosis should be carefully selected based on clinical data, such as remnant liver volume, liver function, and primary liver disease.
CONCLUSION: We report a case of isolated bile leakage after anterior sectionectomy for hepatocellular carcinoma that was managed with Roux-en-Y hepaticojejunostomy at the injured right hepatic duct.
PRESENTATION OF CASES: The right hepatic duct was intraoperatively injured during right anterior sectionectomy. Bile leakage occurred postoperatively in the injured bile duct, although the injured bile duct was repaired with suturing and C-tube drainage was performed to decompress the bile duct during hepatectomy. Unfortunately, nonsurgical treatment was not possible. Therefore, bilio-enteric anastomosis between the right hepatic duct and jejunum was ultimately performed because of the small remnant liver volume and poor liver function.
DISCUSSION: Bilio-enteric anastomosis can avoid sacrificing functioning liver parenchyma, but in cases of hepatocellular carcinoma recurrence, transarterial chemoembolization carries a high risk of liver abscess due to cholangitis in patients undergoing enteric revision. Liver resection or bilio-enteric anastomosis should be carefully selected based on clinical data, such as remnant liver volume, liver function, and primary liver disease.
CONCLUSION: We report a case of isolated bile leakage after anterior sectionectomy for hepatocellular carcinoma that was managed with Roux-en-Y hepaticojejunostomy at the injured right hepatic duct.