Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2022; 10(24): 8742-8748
Published online Aug 26, 2022. doi: 10.12998/wjcc.v10.i24.8742
When should endovascular gastrointestinal anastomosis transection Glissonean pedicle not be used in hepatectomy? A case report
Jian Zhao, Yan-Li Dang
Jian Zhao, Department of Hepatobiliary Surgery, The Affiliated Hospital of Yunnan University, Kunming 650000, Yunnan Province, China
Yan-Li Dang, Department of Obstetrics, First People's Hospital of Yunnan Province, Kunming 650000, Yunnan Province, China
Author contributions: Zhao J and Dang YL designed this report; Zhao J wrote the paper.
Supported by Basic Research Foundation of Yunnan Province, No. 202101AY070001-282.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan-Li Dang, MD, PhD, Chief Doctor, Department of Obstetrics, First People's Hospital of Yunnan Province, No. 157 Jinbi Road, Wuhua District, Kunming 650000, Yunnan Province, China. happylife210@163.com
Received: March 20, 2022
Peer-review started: March 20, 2022
First decision: April 13, 2022
Revised: April 16, 2022
Accepted: July 20, 2022
Article in press: July 20, 2022
Published online: August 26, 2022
Processing time: 148 Days and 17.2 Hours
Abstract
BACKGROUND

The literature on post-hepatectomy bile duct injury (PHBDI) is limited, lacking large sample retrospective studies and high-quality experience summaries. Therefore, we reported a special case of iatrogenic bile duct injury caused by Glissonean pedicle transection with endovascular gastrointestinal anastomosis (endo-GIA) during a right hepatectomy, analyzed the causes of this injury, and summarized the experience with this patient.

CASE SUMMARY

We present the case of a 66-year-old woman with recurrent abdominal pain and cholangitis due to intrahepatic cholangiectasis (Caroli's disease). Preoperative evaluation revealed that the lesion and dilated bile ducts were confined to the right liver, with right hepatic atrophy, left hepatic hypertrophy, and hilar translocation. This problem can be resolved by performing a standard right hepatectomy. Although the operation went well, jaundice occurred soon after the operation. Iatrogenic bile duct injury was considered after magnetic resonance cholangiopancreatography review, and the second operation were performed 10 d later. During the second operation, it was found that the endo-GIA had damaged the lateral wall of the hepatic duct and multiple titanium nails remained in the bile duct wall. This led to severe stenosis of the duct wall, and could not be repaired. Therefore, the injured bile duct was transected, and a hepatic-jejunal-lateral Roux-Y anastomosis was performed at the healthy part of the left hepatic duct. After this surgery, the patient had a smooth postoperative recovery, and the total bilirubin gradually decreased to normal. The patient was discharged 41 d after operation. No anastomotic stenosis was found at the 6 mo of follow-up.

CONCLUSION

Not all cases are suitable for endo-GIA transection of Glissonean pedicle, especially in cases of intrahepatic bile duct lesions. PHBDI caused by endo-GIA is very difficult to repair due to extensive ischemia, which requires special attention.

Keywords: Endovascular gastrointestinal anastomosis; Glissonean pedicle; Hepatectomy; Bile duct injury; Safety; Case report

Core Tip: There have been few reports on post-hepatectomy bile duct injury (PHBDI). In this report, we present a case of PHBDI caused by the wrong choice of transection tool, such as endovascular gastrointestinal anastomosis (endo-GIA), which was successfully saved by reoperation. We wanted to draw attention to the fact that not all cases are suitable for endo-GIA transection of Glissonean pedicle.