[Successful reconstruction of the completely transsected hepato-duodenal ligament. Case report on ischemia tolerance of the human liver].
Incidental complete transsection of the hepato-duodenal ligament occurred in a 59-year-old female patient during gastric surgery. More than three hours later reconstruction of the portal vein, hepatic artery and common bile duct was started, performing end-to-end anastomoses in all cases. The time interval between transsection and restoration of blood flow was 225 minutes for the portal vein and 255 minutes for the right hepatic artery. The left hepatic artery could not be reconstructed. The postoperative course was unremarkable clinically, however, there was an extreme initial rise in the levels of SGOT, SGPT, LDH, and alpha-amylase, followed by a somewhat delayed jaundice with bilirubin levels above 10 mg/dl. In-hospital follow-up examinations were performed 6 and 13 month postoperatively. They revealed good clinical condition, patent blood vessels, slight displacement of the biliary anastomosis by scar tissue without functional stenosis and gradual normalisation of biochemical parameters. The left hepatic lobe became initially necrotic, later atrophic.
D003250:Constriction; D004386:Duodenum / Q000601:surgery*; D005260:Female; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications; D007511:Ischemia / Q000209:etiology*; D008022:Ligaments / Q000293:injuries / Q000601:surgery*; D008099:Liver / Q000098:blood supply*; D008875:Middle Aged
Erfolgreiche Rekonstruktion des komplett durchtrennten Ligamentum hepato-duodenale. Kasuistischer Beitrag zur Ischämietoleranz der menschlichen Leber.