The development of a pyogenic liver abscess following radical resection of cholangiocellular carcinoma with ligation of the right hepatic artery: Report of a case

Abstract

We present herein the case of a pyogenic liver abscess developing from hepatic ischemia caused by resection of the right hepatic artery when a left hemihepatectomy with caudate lobectomy and extrahepatic bile duct resection was performed for cholangiocellular carcinoma. Postoperative cholangiography revealed communication between the abscess cavity and the intrahepatic bile duct. The liver abscess was successfully treated by percutaneous transhepatic drainage. Thus, breakdown of the intrahepatic bile duct due to ischemia may play an important role in the development of a pyogenic liver abscess following hepatic arterial occlusion.

Safety of combined resection of the middle hepatic artery in right hemihepatectomy for hilar biliary malignancy

“…In patients with extrahepatic bilioenteric anastomosis, however, interruption of hepatic arterial flow can often lead to anastomotic insufficiency and/or liver abscess [5], even when normal portal flow is maintained [6,8]. Similarly, following hepatic lobectomy for biliary malignancy, a lack of arterial flow to the remnant hepatic lobe can lead to a distressing postoperative course complicated by dehiscence of the intrahepatic cholangiojejunostomy, liver abscess, and hepatic failure [7,13]. Arterial thrombosis after orthotopic liver transplantation can lead to necrosis of the bile duct [14] and anastomotic and nonanastomotic intrahepatic bile duct strictures, which are assumed to result from ischemia [15,16].…”

“…Preservation of the MHA is the standard technique in right hemihepatectomy for hilar biliary malignancy. Although hypoxic hepatic parenchymal injury does not occur if portal flow is maintained [], interruption of the arterial flow can cause serious postoperative complications related to biliary ischemia, including disruption of the bilioenteric anastomosis and liver abscess [5]. For a series of patients undergoing living‐related liver transplantation success was reported for left lobe grafts without reconstruction of the MHA [9].…”