A case of bile duct-preserving hepatic central bisectionectomy with hepaticojejunostomy for liver metastasis of neuroendocrine tumor with iatrogenic stenosis of hilar bile duct

Abstract

A 78-year-old man had undergone magnetic compression anastomosis (Yamanouchi method) against iatrogenic hilar bile stricture after partial hepatectomy (segment 4) for liver metastasis from rectal primary neuroendocrine tumor. He was referred to our clinic with relapse of liver tumor and hilar biliary stricture. An abdominal CT and cholangiography showed a new tumor, 13mm in diameter, located between the segment 4 and 1, atrophy of the right anterior sector, and bilateral biliary dilataton. As definitive surgery for the both problems, he underwent hepatic central bisectionectomy plus caudate lobectomy for liver tumor and biliary bypass for biliary stricture. In the latter, two side-to-side bilio-digestive anastomoses were made on the left lateral inferior duct and the right posterior sectoral duct. The stenotic hilar bile duct, which exhibited extensive fibrosis, were left in situ to avoid major vessel injury.