PMC6041202_01
Preoperative CT of abdomen cavity.. A CT of abdomen was performed, which showed extravasation of the contrast agent in the region of both hepatic ducts and presence of lesions of the left and right hepatic duct. It also showed presence of biloma and intraabdominal abscess collection (Fig. 1).
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It also showed presence of biloma and intraabdominal abscess collection (Fig. 1).
Intraoperative duplex Roux-en-Y hepatojejunostomy.. We performed the Orr incision to open the abdominal cavity. During the exploration we found high type (Class E) transection lesion of right and left hepatic duct, and we decided to do Roux-en-Y hepaticojejunostomy. Because of the lesion of the both hepatic ducts in the hilus of the liver, biliary peritonitis and poor quality of the remaining part of the hepatic ducts, we created a part of anastomosis between the jejunum and liver capsule with polydioxanone suture (PDS) 4-0 without Witzel enterostomy and transhepatic biliary stent. We made two separate hepaticojejunal anastomoses (left and right) that we partly connected to the liver capsule, where we had a defect of hepatic ducts (portoenterostomia) (Fig. 2). After that we made entero-entero anastomoses to continue the continuity of the digestive tube. With the evacuation of the abscess collections, the abdominal cavity toilet and the placement of abdominal drain, we completed the surgical procedure.
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Witzel enterostomy and transhepatic biliary stent. We made two separate hepaticojejunal anastomoses (left and right) that we partly connected to the liver capsule, where we had a defect of hepatic ducts (portoenterostomia) (Fig. 2).
MRCP one year after surgery procedure.. We did magnetic resonance cholangiopancreatography (MRCP) one year after the surgical procedure, which showed the proper width of the intrahepatic bile ducts, with no signs of stenosis of anastomoses (Fig. 3).
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We did magnetic resonance cholangiopancreatography (MRCP) one year after the surgical procedure, which showed the proper width of the intrahepatic bile ducts, with no signs of stenosis of anastomoses (Fig. 3).