Delayed-onset isolated injury of the right posterior segment duct after laparoscopic cholecystectomy: a report of hepatic segmental atrophy induction.
Laparoscopic cholecystectomy resulted in various bile duct injuries. We present an unusual case of right posterior segment (RPS) duct injury detected 35 days after laparoscopic cholecystectomy. Imaging studies revealed that RPS duct was severed probably because of thermal damage from electrocautery. Initially, resection of RPS parenchyma had been planned, but atrophy induction of the involved hepatic parenchyma was attempted because the patient rejected the initial treatment plan. This treatment comprised embolization of RPS portal branch to inhibit bile production, induction of heavy adhesion at the bile leak site to ensure percutaneous transhepatic biliary drainage (PTBD) clamping, and clamping of PTBD tube to accelerate RPS atrophy. This procedure took 4 months before PTBD tube removal. The patient has showed no complications for 30 months to date. Although this atrophy induction approach cannot be regarded as a generally accepted treatment, we believe it can be considered a feasible option in rare circumstances such as this.
Hwang
Shin
S
Division of Hepatobiliary Surgery and Liver Transplantation, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. shwang@amc.seoul.kr
Lee
Sung-Gyu
SG
Lee
Young-Joo
YJ
Ha
Tae-Yong
TY
Ko
Gi-Young
GY
Song
Gi-Won
GW
D001284:Atrophy; D001653:Bile Ducts, Intrahepatic / Q000293:injuries* / Q000601:surgery; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D004564:Electrocoagulation / Q000009:adverse effects; D005260:Female; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications; D013997:Time Factors