A Case of Multiple Liver Abscesses, Obstruction of Right Portal Vein and Rupture of Hepatic Arterial Aneurysm due to Intrahepatic Gallstones

Yutaka Ozeki, Nagaki Matsubara, Mitsuharu Kokubo, Takashi Uchiyama

Department of Surgery, National Tosei Hospital

A 72-year-old man who had undergone cholecystectomy and choledochojejunostomy for cholelithiasis 6 years ago was transferred to our hospital because of chills, high fever and tarry stool. He had been found to have right intrahepatic gallstones by computed tomography (CT) one year ago. Severe anemia, leucocytosis and elevation of hepatobiliary enzymes were shown on admission. CT disclosed a calcification in the right lobe of the liver and multiple cystic lesions in the posterior segment of the liver. Hepatic angiography showed extravasation and pooling of contrast medium at the posterior branch of the right hepatic artery. Transmesenteric portography revealed obstruction of the right branch of the portal vein. Under a diagnosis of multiple hepatic abscesses, obstruction of the right portal vein and rupture of the hepatic arterial aneurysm due to intrahepatic gallstones, urgent right hepatic lobectomy was performed. Transcatheter arterial embolization was not indicated because of the obstruction of the portal vein. The removed gallstones were calcium bilirubinate stones, and the resected liver showed multiple abscesses in the posterior segment of the liver. His postoperative course was uneventful except for minor leakage from the choledochojejunostomy.

Key words
intrahepatic gallstones, rupture of hepatic aneurysm and obstruction of portal vein

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

Accepted
December 7, 1994

To read the PDF file you will need Abobe Reader installed on your computer.