HPB
DOI:10.1111/hpb.12053
IMAGE OF THE ISSUE
Ruptured hepatic artery after hepatectomy Michael Linecker, Mickael Lesurtel & Pierre-Alain Clavien Department of Surgery, University Hospital Zurich, Zurich, Switzerland
Received 29 November 2012; accepted 17 December 2012
Correspondence Pierre-Alain Clavien, Department of Surgery, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland. Tel: +41 44 255 23 00. Fax: +41 44 255 44 49. E-mail: [email protected]
A 75-year-old man with a perihilar cholangiocarcinoma B3-R,PV0,HA0, V25% (Bismuth IIIa)1 underwent an extended right hepatectomy after right portal vein embolization. Percutaneous transhepatic drains were placed to decompress the biliary system but the patient experienced recurrent cholangitis for 6 months as a consequence of repetitive cholangio-stent displacement. Two weeks prior to a hepatectomy, Candida albicans was cultured in the bile but antifungal therapy was not prescribed because of adequate biliary drainage. An extended right hemihepatectomy was uneventful but on the fourth postoperative day, the patient experienced haemorrhagic shock as a result of intraabdominal bleeding. During an emergency laparotomy resection and anastomosis of a segment of the hepatic artery was performed successfully for rupture of the proper hepatic artery. The patient was discharged at post-operative day 40 after prolonged antifungal therapy. Histopathological examination showed a candida arteritis of the ruptured artery (Fig. 1). Intra-operative manipulation on an already infected artery may have caused this early post-operative bleeding. This kind of infection is typical in immunocompromised patients, but to our knowledge, it has not been reported on the hepatic artery. Conflicts of interest None declared. Reference 1 DeOliveira ML, Schulick RD, Nimura Y, Rosen C, Gores G, Neuhaus P et al. (2011) New staging system and a registry for perihilar cholangiocarcinoma. Hepatology 53:1363–1371.
Figure 1 The low-magnification image shows a thickened arterial
adventitia with granulocyte infiltration. In the tunica media (highmagnification insertion), fungal hyphae (arrow) are seen indicating candida arteritis
HPB 2013, 15, 916
© 2013 International Hepato-Pancreato-Biliary Association
DOI:10.1111/hpb.12053
IMAGE OF THE ISSUE
Ruptured hepatic artery after hepatectomy Michael Linecker, Mickael Lesurtel & Pierre-Alain Clavien Department of Surgery, University Hospital Zurich, Zurich, Switzerland
Received 29 November 2012; accepted 17 December 2012
Correspondence Pierre-Alain Clavien, Department of Surgery, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland. Tel: +41 44 255 23 00. Fax: +41 44 255 44 49. E-mail: [email protected]
A 75-year-old man with a perihilar cholangiocarcinoma B3-R,PV0,HA0, V25% (Bismuth IIIa)1 underwent an extended right hepatectomy after right portal vein embolization. Percutaneous transhepatic drains were placed to decompress the biliary system but the patient experienced recurrent cholangitis for 6 months as a consequence of repetitive cholangio-stent displacement. Two weeks prior to a hepatectomy, Candida albicans was cultured in the bile but antifungal therapy was not prescribed because of adequate biliary drainage. An extended right hemihepatectomy was uneventful but on the fourth postoperative day, the patient experienced haemorrhagic shock as a result of intraabdominal bleeding. During an emergency laparotomy resection and anastomosis of a segment of the hepatic artery was performed successfully for rupture of the proper hepatic artery. The patient was discharged at post-operative day 40 after prolonged antifungal therapy. Histopathological examination showed a candida arteritis of the ruptured artery (Fig. 1). Intra-operative manipulation on an already infected artery may have caused this early post-operative bleeding. This kind of infection is typical in immunocompromised patients, but to our knowledge, it has not been reported on the hepatic artery. Conflicts of interest None declared. Reference 1 DeOliveira ML, Schulick RD, Nimura Y, Rosen C, Gores G, Neuhaus P et al. (2011) New staging system and a registry for perihilar cholangiocarcinoma. Hepatology 53:1363–1371.
Figure 1 The low-magnification image shows a thickened arterial
adventitia with granulocyte infiltration. In the tunica media (highmagnification insertion), fungal hyphae (arrow) are seen indicating candida arteritis
HPB 2013, 15, 916
© 2013 International Hepato-Pancreato-Biliary Association
