How to Rescue a Extreme Vasculobiliary Injury from Liver Failure

Abstract

To describe a case treated with "tricks of the trade", in order to avoid liver transplantation in a patient with extreme vasculobiliary injury (VBI). A 22 years old woman underwent a open cholecystectomy with bile duct exploration. An important inflammatory process was found and massive bleeding from the hepato-duodoenal pedicle, requiring several stiches of hemostasis, ending the surgery without proper identification of the pedicle structures. Patient developed jaundice and commitment of conscience. Three days after, she was transferred due to increased deterioration of clinical condition. A CT scan was performed revealing a right liver lobe infarct, absence of the right and left hepatic artery, normal flow of an accessory artery from left gastric artery, portal vein thrombosis. Patient was taken to the OR. Surgical findings where: bile peritonitis, right hepatic lobe necrosis and ischemia of left lobe, complete resection of the common bile duct at the level of the confluence of right and left ducts, thick stiches on main portal vein and complete section of the hepatic artery. The accessory artery of the left gastric was not damaged. With those findings, a right hepatectomy was performed with revascularization of the left hepatic lobe using a jump-graft from superior mesenteric vein to left portal branch at the level of REX process, with a cadaveric iliac vein and Roux-en-Y hepaticojejunostomy to the left hepatic duct. After four months, patient has adequate biliary drainage and normal portal and arterial flows with good regeneration of the left hepatic lobe.