PMC3015369_01
Drip infusion cholangiography demonstrating the normal common hepatic duct but not representing the gallbladder. Figure 1b. Fistulogram demonstrating the posterior segmentai bile duct having no connection to the common bile duct. Figure 1c. Intraoperative cholangiography demonstrating a confluence of the right anterior hepatic duct and left hepatic duct without posterior segmental branch. The injured posterior hepatic duct was close to the clips. Figure 1d. Postoperative cholangiography after right hepatic lobectomy.
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F1
Fistulography revealed a communication between the abscess cavity and the right posterior hepatic duct and no communication between the abscess cavity and the common hepatic duct (Figure 1b). Intraoperative cholangiography revealed the right anterior hepatic duct and the left hepatic duct, and the right posterior hepatic duct was not visualized (Figure 1c). The patient's postoperative course was uneventful, and the postoperative cholangiography through T-tube demonstrated no biliary leakage from the biliary tree (Figure 1d).
Computed tomography after laparoscopic cholecystectomy demonstrating an abnormal fluid collection in the right upper quadrant region. Figure 2b. Computed tomography before hepatic resection demonstrating a subcapsular hematoma of the right hepatic lobe and an abscess in the subsegment.
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F2
Computed tomography (CT) showed fluid collection in the right upper quadrant (Figure 2a), and a percutaneous drainage guided by ultrasonography was performed. The presence of a subcapsular hematoma of the right hepatic lobe and of an abscess in the posterosuperior subsegment was observed (Figure 2b).
A schema of the biliary system during hepatic resection in our case. F: Fistula by percutaneous abscess drainage; C: Cavity; H: Hematoma; AHD: Anterior hepatic duct; PHD: Posterior hepatic duct; LHD: Left hepatic duct; RPV: Right portal vein; PV: Portal vein; CBD: Common bile duct; CD: Cystic duct, which ran in parallel with CBD and entered in lower part of CBD.
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F3
The proximal stump of the right posterior hepatic duct could not be identified (Figure 3).