Minimal access endoscopic debridement of right hepatic necrosis

Abstract

Introduction: Hepatic necrosis secondary to hepatic artery injuries can be devastating and will often require surgical debridement. Conventionally this is done as an open laparotomy with washout and debridement. We report the first case of significant hepatic necrosis for which a minimal access hepatic necrosectomy was performed via an endoscopic approach, hence reducing morbidity and mortality for the patient. Case Report: A 63-year-old female with type 5 choledochal cyst underwent a left hepatectomy and Roux-en-y biliary reconstruction. This was complicated by an arterial injury with pseudoaneurysm requiring radiological embolization and subsequent right hepatic thrombosis leading to hepatic necrosis. She had a prolong intensive care unit (ICU) admission with percutaneous drainage and intravenous antibiotics for two months. A minimal access necrosectomy was eventually required as an elective day surgery procedure. The patient improved significantly and has been well apart from recurrent cholangitis from a possible hepatic duct stenosis from the initial hepatectomy. Conclusion: Hepatectomies complicated postoperatively by infected hepatic necrosis can be successfully managed via minimal access hepatic necrosectomies. This has multiple benefits such as decreased hospital stay and quicker recovery time.