Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
권호 표지

Therapeutic induction of hepatic atrophy for isolated injury of the right posterior sectoral duct following laparoscopic cholecystectomy

  • Hwang, Shin (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yoon, Sam-Youl (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jung, Sung-Won (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • NamGoong, Jung-Man (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Gil-Chun (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Gwon, Dong-Il (Diagnostic Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Sung-Gyu (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • Published : 2011.08.31
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Abstract

Laparoscopic cholecystectomy has resulted in various bile duct injuries. Treatment of these injuries is usually difficult and often leads to an intractable clinical course. We herein present a case of isolated right anterior sector (RAS) duct injury induced by laparoscopic cholecystectomy. The bile duct injury was successfully treated by hepatic atrophy induction. Imaging studies revealed that the RAS duct was severed, probably due to rare anatomical variations. Considering the difficulty in surgical reconstruction, atrophy induction of the involved hepatic parenchyma was attempted. This treatment consisted of embolization of the RAS portal branch to inhibit bile production, induction of heavy adhesion at the bile leak site to ensure percutaneous pigtail clamping, and sequential clamping and removal of pigtail catheters. This procedure took 3 months prior to pigtail catheter removal. She was free from other complications during the first 12 months and to date. She will be followed up for 5 years overall including surveillance for hepatobiliary complications. Although this therapeutic induction of atrophy approach is not universally applicable, it can be considered to be a feasible option in unique situations such as this one.

Keywords

References

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