18 May, 2020

Major biliovascular injury associated with cholecystectomy with the need for percutaneous arterial revascularization and staged right hepatectomy: case report

Pablo Ignacio San Martin FERRADA
Héctor Fabio Losada MORALES
Jorge Alberto Silva ABARCA
Paula Inés Flores MUÑOZ
DOI: 10.1590/0102-672020190001e1493
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INTRODUCTION

The cholecystectomy is currently one of most frequently performed surgeries. The incidence of secondary bile duct injury occurs between 0.2-0.3% in the open technique, while for the laparoscopic is 0.5-0.8%7,9. In terms of the iatrogenic vascular injuries associated with those of the bile duct, there are reports between 12-39%1,4,5. Such injuries worsen the patient›s prognosis and complicate their management. The best resolution for these has not yet been defined.

Among the vascular injuries associated with the cholecystectomy, almost 90% are in right hepatic artery. There are rare vascular injuries associated with bile duct injury that include the hepatic artery proper, the common hepatic artery, the main trunk of the portal vein, the right branch of the portal vein or a major venous injury associated with injury of the right hepatic artery. The literature contains few reports of these cases of major biliovascular injury.

Hepatic ischemia with hepatic parenchymal infarction occurs frequently and may require liver resection or transplant. Death associated with this type of injury is close to 50%2,8.


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ABCD – BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY is a periodic with a single annual volume in continuous publication, official organ of the Brazilian College of Digestive Surgery - CBCD.

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