title: Bowel injury associated with liver surgery for hepatocellular carcinoma.
abstract: OBJECTIVE
  Bowel injury associated liver surgery is rare but can be fatal if not adequately treated. The contribution of underlying liver disease and previous hepatectomy to bowel injury in hepatectomy for hepatocellular carcinoma is unknown.
  
  
  METHODS
  Clinical records of 531 patients who underwent hepatic resection without combined resection of the biliary tract or intestine for hepatocellular carcinoma during 13 years were reviewed. Differences in incidence of bowel injury according to presence or absence of liver cirrhosis, technique of hepatectomy, and history of hepatectomy were investigated. Outcome after treatment also was reviewed.
  
  
  RESULTS
  Bowel injury occurred in 5 patients (0.9%). Previous hepatectomy history was associated with an increased incidence of bowel injury [repeat hepatectomy, 3/91 (3.3%), and first hepatectomy, 2/440 (0.5%), p = 0.038]. Injury was recognized intraoperatively in two patients and postoperatively in three. In the former two patients, the injured bowel was repaired immediately but a fistula still developed in one patient. One patient with a fistula eventually required temporary fecal diversion and eventually limited colectomy. The other three patients were treated by continuous external drainage, but two of them required debridement or colic sleeve resection.
  
  
  CONCLUSIONS
  Previous hepatectomy increases the risk for bowel injury during hepatectomy. Care must be taken to prevent adhesion to the hepatic cut surface. Careful use of electrocautery to prevent burn injury also should be taken.
authors.affiliation: Department of Hepato-Biliary-Pancreatic and Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan. m8827074@msic.med.osaka-cu.ac.jp
authors.forename: Shogo
authors.initials: S
authors.lastname: Tanaka
authors.forename: Hiromu
authors.initials: H
authors.lastname: Tanaka
authors.forename: Shoji
authors.initials: S
authors.lastname: Kubo
authors.forename: Taichi
authors.initials: T
authors.lastname: Shuto
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Takemura
authors.forename: Takatsugu
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Takahiro
authors.initials: T
authors.lastname: Uenishi
authors.forename: Seikan
authors.initials: S
authors.lastname: Hai
authors.forename: Harushi
authors.initials: H
authors.lastname: Osugi
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hirohashi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003106:Colon / Q000293:injuries* / Q000473:pathology; D004386:Duodenum / Q000293:injuries* / Q000473:pathology; D005260:Female; D005402:Fistula; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged