ABSTRACT
We describe a case of severe acute bleeding from an arterio-duodenal fistula between the duodenum and a hepato-hepatic by-pass. Emergency ligation of the common hepatic artery was successfully achieved. After hepatic artery ligation, revascularization of the liver in human subjects occurs through inferior phrenic, pancreatico-duodenal and intercalary de novo arteries.
Subject(s)
Duodenal Diseases/etiology , Duodenal Diseases/surgery , Hepatic Artery/surgery , Intestinal Fistula/etiology , Intestinal Fistula/surgery , Postoperative Complications/etiology , Postoperative Complications/surgery , Vascular Fistula/etiology , Vascular Fistula/surgery , Duodenum/surgery , Humans , Ligation , Liver/surgery , Male , Middle AgedABSTRACT
The aim of our study was to identify the best treatment for bile leakage from the gallbladder or hepatic bed as a result of laparoscopic cholecystectomy. Two hundred and fifty laparoscopic cholecystectomies were performed in our department from January 1997 to January 1999 and bile leak was identified in 5 cases (2%). In one case, a right subphrenic collection was detected and resolved with a percutaneous drainage. At ERCP all cases showed a small leak from an accessory hepatic duct (2 pts.) or from the hepatic bed (3 pts.), successfully managed with an immediate endoscopic sphincterotomy, with placement of a nasobiliary tube or a biliary endoprosthesis. The incidence of leakage from an accessory hepatic or from Luschka's duct is not well known. This complication can be successfully managed with endoscopic treatment.
