2003 Volume 23 Issue 6 Pages 911-917
Background: Selecting the treatment of choice for postoperative life-threatening massive abdominalhemorrhage has been difficult. Case: A 65-year-old woman underwent extended left lobectoy together withreconstruction of both the hepatic artery and portal vein in the treatment for hilar cholangiocarcinoma. Herpostoperative course was stable except for a trivial bile leakage from an intraabdominal drainage tube untila sudden copious intra-abdominal hemorrhage followed by shock occurred on the twelfth postoperative day. An emergency celiotomy was performed immediately. Bleeding was caused by breakdown of both theanastomosis sites of the hepatic artery and portal vein accompanied with thrombus. The cholangiojejunostomywas intact. The hepatic artery was ligated and the portal vein was reconstructed with interpositionof a saphenous vein graft using the portocaval bypass technique. The postoperative course was uneventfuland proceeded well without hypoxic liver failure, and the patient was discharged. This case suggests thatceliotomy should be considered first rather than IVR in some special cases, such as those showing a suddendeterioration.
