A Case of Liver Infarction after Surgery for Cancer of the Hepatic Hilus

Yutaka Ozeki, Nagaki Matsubara, Mitsuharu Kokubo, Kenji Ishikawa, Takashi Uchiyama, Suguru Sawada

Department of Surgery, National Tosei Hospital

A 67-year-old man was admitted to our hospital because of jaundice. Percutaneous cholangiography showed an irregular obstruction of the common hepatic duct. Stenosis upstream from the obstruction was shown beyond the bifurcation of the anterior and posterior branches on the right side and that of the dorsolateral and ventrolateral branches on the left side. The rate of retention of indocyanine green in 15 minutes was 38.8∼60.4% in spite of percutaneous biliary drainage. Under a diagnosis of cancer of the hepatic hilus, medial segmentectomy with caudate lobectomy was performed. The arterial branch of the ventrolateral segment (S3) entered into Glisson's capsule of the left hepatic duct and was ligated and divided. By histologic examination, a moderately differentiated tubular adenocarcinoma was demonstrated. On the 6th postoperative day (POD), glutamic pyruvic transaminase was elevated again and on the 10 th POD, fever was encountered. On the 15th POD, contrast-enhanced computed tomography revealed a non-enhanced low density area consistent with the area of S3. Therefore, a diagnosis of liver infarction was made. On the 18th POD, an emergency operation was performed because of shock. Then, hepatic necrosis consistent with the area of S3 was recognized. The area of liver infarction was consistent with that of the blood supply of the ligated artery. The relationship between the ligation of the hepatic artery and the infarction of the liver was discussed.

Key words
ligation of the hepatic artery, liver infarction, carcinoma of the hepatic hilus

Reprint requests
Yutaka Ozeki Department of Surgery, National Tosei Hospital
762-1 Nagasawa, Shimizu-cho, Sunto-gûn, Shizuoka, 411 JAPAN

Accepted
May 11, 1994

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