Published online Oct 16, 2023. doi: 10.12998/wjcc.v11.i29.7234
Peer-review started: August 16, 2023
First decision: September 4, 2023
Revised: September 10, 2023
Accepted: September 19, 2023
Article in press: September 19, 2023
Published online: October 16, 2023
Processing time: 58 Days and 11 Hours
The occurrence of long-term bilioenteric anastomotic stenosis can readily induce liver atrophy and hyperplasia, thereby causing significant alterations in the anatomical and morphological aspects of the liver. This condition significantly hampers the accuracy of preoperative imaging diagnosis, while also exacerbating the complexity of surgical procedures and the likelihood of complications.
A 60-year-old female patient was admitted to the hospital presenting with recurring epigastric pain accompanied by a high fever. The patient had a history of cholecystectomy, although the surgical records were not accessible. Based on preoperative imaging and laboratory examination, the initial diagnosis indicated the presence of intrahepatic calculi, abnormal right liver morphology, and acute cholangitis. However, during the surgical procedure, it was observed that both the left and right liver lobes exhibited evident atrophy and thinness. Additionally, there was a noticeable increase in the volume of the hepatic caudate lobe, and the original bilioenteric anastomosis was narrowed. The anastomosis underwent enlargement subsequent to hepatectomy. As a consequence of the presence of remaining stones in the caudate lobe, the second stage was effectively executed utilizing ultrasound-guided percutaneous transhepatic catheter drainage. Following the puncture, three days elapsed before the drain tip inadvertently perforated the liver, leading to the development of biliary panperitonitis, subsequently followed by pulmonary infection. The patient and her family strongly refused operation, and she died.
The hepatic atrophy-hypertrophy complex induces notable alterations in the anatomical structure, thereby posing a substantial challenge in terms of imaging diagnosis and surgical procedures. Additionally, the long-term presence of hepatic fibrosis changes heightens the likelihood of complications arising from puncture procedures.
Core Tip: This case report presents a recurrent occurrence of acute cholangitis caused by persistent stenosis following a bilioenterostomy, leading to the development of the hepatic atrophic hyperplasia complex. This complex is characterized by notable atrophy in the left and right hepatic lobes and significant hyperplasia in the caudate lobe. The preoperative imaging failed to accurately detect these anatomical alterations, and the subsequent delayed puncturing of the liver envelope through puncture drainage resulted in biliary peritonitis and ultimately, mortality. Therefore, a comprehensive preoperative surgical history, precise comprehension of anatomical anomalies and pathological changes are crucial for effective management in such cases.