title: Hepatic parenchymal atrophy induction for intractable segmental bile duct injury after liver resection.
abstract: Liver resection can result in various types of bile duct injuries but their treatment is usually difficult and often leads to intractable clinical course. We present an unusual case of hepatic segment III duct (B3) injury, which occurred after left medial sectionectomy for large hepatocellular carcinoma and was incidentally detected 1 week later due to bile leak. Since the pattern of this B3 injury was not adequate for operative biliary reconstruction, atrophy induction of the involved hepatic parenchyma was attempted. This treatment consisted of embolization of the segment III portal branch to inhibit bile production, induction of heavy adhesion at the bile leak site and clamping of the percutaneous transhepatic biliary drainage (PTBD) tube to accelerate segment III atrophy. This entire procedure, from liver resection to PTBD tube removal took 4 months. This patient has shown no other complication or tumor recurrence for 4 years to date. These findings suggest that percutaneous segmental portal vein embolization, followed by intentional clamping of external biliary drainage, can effectively control intractable bile leak from segmental bile duct injury.
authors.affiliation: Department of Surgery, University of Ulsan College of Medicine, Seoul, Korea. shwang@amc.seoul.kr
authors.forename: Shin
authors.initials: S
authors.lastname: Hwang
authors.forename: Gil-Chun
authors.initials: GC
authors.lastname: Park
authors.forename: Tae-Yong
authors.initials: TY
authors.lastname: Ha
authors.forename: Gi-Young
authors.initials: GY
authors.lastname: Ko
authors.forename: Dong-Il
authors.initials: DI
authors.lastname: Gwon
authors.forename: Young-Il
authors.initials: YI
authors.lastname: Choi
authors.forename: Gi-Won
authors.initials: GW
authors.lastname: Song
authors.forename: Sung-Gyu
authors.initials: SG
authors.lastname: Lee
mesh_terms: D001284:Atrophy; D001646:Bile / Q000378:metabolism; D001649:Bile Duct Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D001652:Bile Ducts / Q000293:injuries* / Q000378:metabolism / Q000473:pathology; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D003250:Constriction; D004322:Drainage; D004621:Embolization, Therapeutic; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D033162:Incidental Findings; D008099:Liver / Q000098:blood supply* / Q000473:pathology / Q000601:surgery*; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D011237:Predictive Value of Tests; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome