Introduction
Gastric Mucosal Ischemia (GMI) following left hepatectomy
is a rare post operative complication, never described in literature.
Biliary leak is the most common cause of postoperative morbidity after hepatic resection, leading to prolonged hospital
stay and drainage tube manteinance, but also worst long-term
outcomes in oncological patients delaying the start of chemyotherapies [1].
This case report describes a rare case of gastric mucosal ischemia caused by biliary leakage after left hepatectomy.
Case report
A 60-year-old woman underwent left hepatectomy with
lymphadenectomy for intrahepatic cholangiocarcinoma. The
patient developed intense abdominal pain in 9th Postoperative
Day (POD).
The subsequent CT scan (Figure 1) described: “a 6 cm biloma,
pressing and displacing the antral region of the stomach, air
emboli in the short gastric veins, edematous wall thickening of
the fundus with regions of reduced or absent mucosal enhancement, highlighted with green arrows”. Following conservative
treatment, the patient fully recovered, being discharged on the
28th POD.
Discussion
The presented image (Figure 1) illustrates the uncommon
postoperative complication of Gastric Mucosal Ischemia (GMI)
following Liver Resection (LR).
GMI is an infrequent complication encountered after LR.
In this case it is attributed to an exceptional observation: the
mechanical effects of the biloma causing compression and displacement of gastric vessels, resulting in compromised blood
supply to the gastric mucosa and subsequent ischemia. The diagnosis is displayed by both the CT scan and subsequent gastroscopy shown in the lower right panel of the image.
Bile leak remains one of the mostsignificant complications in
liver surgery [1]. In this presentation, we are witnessing an extraordinary finding, a rare instance that to our knowledge, has
never been documented before in literature. The pathophysiological mechanism might be linked to that of Delayed Gastric
Emptying (DGE) after left hepatectomy. DGE is probably caused
by adhesion between the stomach and the cut surface of the
liver and displacement of the stomach [2]. Similarly, TGMI in
this instance seems to be the result of a biloma coming from the
cut liver surface compressing the gastric vessels.
Presenting this image might aid in the early detection of
similar complications by other medical practitioners, promoting timely intervention. In fact, early recognition to initiate appropriate management significantly contributes to favorable
patient outcomes. Continued research and exploration of novel
preventive strategies to minimize bile leak are warranted to further enhance patient care and surgical outcomes in the field of
liver surgery [3].
Declarations
Funding: The authors have not declared a specific grant for
this research from any funding agency in the public, commercial
or not-for-profit sectors.
Conflict of interests: Authors declare no conflict of interest
for this article.
Ethical approval: Reviews do not need any ethical approvals.
Consent to participate: Obtained.
Consent to publish: Obtained.
Availability of data and material (data transparency): Not
applicable.
Code availability (software application or custom code): Not applicable.
Authors’ contributions: Study conception and design: Giuliante F, Langellotti L; data collection: Langellotti L; draft manuscript preparation: Taliente F, Langellotti L, Longo F, Mele C,
Ardito F, Giuliante F. All authors reviewed the results and approved the final version of the manuscript.
References
- Koch Moritz, O James Garden, Robert Padbury, Nuh N Rahbari,
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- Yoshida Hiroshi, Yasuhiro Mamada, Nobuhiko Taniai, Yoshiaki
Mizuguchi, Tetsuya Shimizu, et al. Fixation of the greater omentum for prevention of delayed gastric emptying after left hepatectomy with lymphadenectomy for cholangiocarcinoma. Journal of Hepato-Biliary-Pancreatic Surgery. 2007; 14: 392-396.
- Zimmitti Giuseppe, Jean-Nicolas Vauthey, Junichi Shindoh, Ching-Wei D Tzeng, Robert E Roses, et al. “Systematic use of an
intraoperative air leak test at the time of major liver resection
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