A case of left hepatectomy performed for intrahepatic choledocholithiasis after Longmire's operation performed on traumatic biliary tract stricture

Abstract

A case is a woman in her 50's. She was transported to our hospital with liver injury caused by traffic trauma 9 years ago. The rupture at the origin of the left hepatic duct was found, and it was difficult to try internal fistula by PTBD. Maintenance hemodialysis was required during the course of treatment, hepatic resection was judged impossible. Therefore, we performed intrahepatic bile duct jejunostomy with a B3 bile duct (Longmire's operation). However, cholangitis symptoms appeared frequently in 7 years after surgery, and it became a diagnosis of intrahepatic choledocholithiasis. We judged it as a surgical indication and performed left hepatectomy. A postoperative bile fisture occurred but it cured conservatively and she was discharged on the 43 rd day.

Longmire surgery may be performed for biliary stricture which was incurable with IVR, but intrahepatic bile duct calculus may occur after long period as in this case. Therefore, careful follow-up observation was considered necessary.