A CASE OF BILE LEAKAGE FROM THE LEFT TRIANGULAR LIGAMENT OF THE LIVER AFTER TOTAL GASTRECTOMY

Abstract

The left triangular ligament of the liver is frequently transected using electrocautery without closure of the surgical stump in the course of the upper abdominal surgery for wide exposure of the cardiac parts of the stomach. There, however, have been few reports of some complications due to this procedure. We experienced a case of postoperative bile leakage from the cut-edge of the hepatic side of the left triangular ligament transected during a total gastrectomy.
A 75-year-old man underwent a total gastrectomy with a distal pancreatectomy, a splenectomy, a dissection of the regional lymph nodes including those in the hepatoduodenal ligament, and a cholecystectomy for Borrmann-type3 gastric cancer. Soon after the operation, a large amount of bile discharge through a drain placed in the left subphrenic space was noticed. Seven hours later, an exploratory laparotomy revealed bile leakage from the transected left triangular ligament of the hepatic side. It was sutured afte a partial resection for sampling. Histological examination disclosed the existence of large aberrant bile ducts in the laft triangular ligament. Thereafter, his postoperative course was uneventful.
This complication is thought to be rare, but great care should be exercised if the surgical stump of the ligament is left unclosed after transection.