A case of recurrent cholangitis after bile duct injury during laparoscopic cholecystectomy: Value of scintigraphy with Tc-99m GSA and hepatobiliary scintigraphy for indication of lobectomy

Abstract

A 39-year-old woman with acute cholecystitis and gallstones underwent laparoscopic cholecystectomy. She suffered from recurrent episodes of cholangitis due to injury of the major bile ducts during laparoscopic cholecystectomy. Hepatobiliary scintigraphy with Tc-99m Sn-N-pyridoxyl-5-methyltryptophan was performed. Although normal bile excretion was found from the left hepatic duct to the percutaneous transhepatic biliary drainage (PTBD) tube, excretion from the right hepatic lobe was prolonged. Scintigraphy with Tc-99m diethylenetriaminepentaacetic acid-galactosyl human serum albumin demonstrated atrophy of the right hepatic lobe and enlargement of the left hepatic lobe. Cholangiography via the PTBD tube revealed complete obstruction of the left hepatico-jejunal anastomosis and could not enhance the right intrahepatic bile duct. A right hepatic lobectomy was performed because of the atrophy, glissonitis and the absence of an appropriate bile duct for reconstruction. Postoperatively she was active and exhibited no evidence of recurrent cholangitis.

Liver Resection and Transplantation in the Management of Iatrogenic Biliary Injury

“…Six patients underwent right hepatectomy as definitive management of an atrophic right liver, with five having a prior repair and five an associated vascular injury. There are 23 reports of right hepatic resection in the English literature, all performed for liver atrophy, sepsis, or unreconstructable right hepatic ducts [2][3][4][5][6][7][8][9][10][11][12].…”

“…Only a very small number of patients have been reported in the literature as requiring liver resection [2–13] or transplantation [10–12, 14, 15] in the management of bile duct injury following cholecystectomy. The commonest indication for liver resection in the treatment of ongoing biliary sepsis or atrophy after injury has been to remove the right liver [2–12]. Liver transplantation has been reported most commonly for management of secondary biliary cirrhosis, usually as a long‐term complication of biliary injury [11, 12, 15].…”

“…Only a very small number of patients have been reported in the literature as requiring liver resection [2][3][4][5][6][7][8][9][10][11][12][13]o r transplantation [10-12, 14, 15] in the management of bile duct injury following cholecystectomy. The commonest indication for liver resection in the treatment of ongoing biliary sepsis or atrophy after injury has been to remove the right liver [2][3][4][5][6][7][8][9][10][11][12]. Liver transplantation has been reported most commonly for management of secondary biliary cirrhosis, usually as a long-term complication of biliary injury [11,12,15].…”