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Case Report
Minimal access endoscopic debridement of right hepatic necrosis
1 Department of Hepatobiliary Surgery, Princess Alexandara Hospital, Queensland, Australia
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Arun Nadarajah
Department of Hepatobiliary Surgery, Princess Alexandara Hospital, Queensland,
Australia
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Article ID: 100103Z12AN2022
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Nadarajah A, Hodgkinson P, Fawcett J. Minimal access endoscopic debridement of right hepatic necrosis. J Case Rep Images Surg 2022;8(1):22–25.ABSTRACT
Introduction: Hepatic necrosis secondary to hepatic artery injuries can be devastating and will often require surgical debridement. Conventionally this is done as an open laparotomy with washout and debridement. We report the first case of significant hepatic necrosis for which a minimal access hepatic necrosectomy was performed via an endoscopic approach, hence reducing morbidity and mortality for the patient.
Case Report: A 63-year-old female with type 5 choledochal cyst underwent a left hepatectomy and Roux-en-y biliary reconstruction. This was complicated by an arterial injury with pseudoaneurysm requiring radiological embolization and subsequent right hepatic thrombosis leading to hepatic necrosis. She had a prolong intensive care unit (ICU) admission with percutaneous drainage and intravenous antibiotics for two months. A minimal access necrosectomy was eventually required as an elective day surgery procedure. The patient improved significantly and has been well apart from recurrent cholangitis from a possible hepatic duct stenosis from the initial hepatectomy.
Conclusion: Hepatectomies complicated postoperatively by infected hepatic necrosis can be successfully managed via minimal access hepatic necrosectomies. This has multiple benefits such as decreased hospital stay and quicker recovery time.
Keywords: Endoscopic, Hepatectomy, Minimal access, Necrosectomy
SUPPORTING INFORMATION
Author Contributions
Arun Nadarajah - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Peter Hodgkinson - Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Jonathan Fawcett - Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2022 Arun Nadarajah et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
