Limits...
Fatal liver injury complicated by percutaneous catheter drainage after distal pancreatosplenectomy in a patient with pancreatic cancer.

Lee SH, Kang CM, Chung YE, Park JY, Lee WJ - Korean J Hepatobiliary Pancreat Surg (2014)

Bottom Line: Percutaneous catheter drainage has been commonly used for managing for the postoperative management of abnormal fluid collection.Removal of the catheter is rarely associated with occurrence of life-threatening complication such as serious liver damage.We suggest that prudent decision for timing of catheter removal and meticulous care during procedure can reduce the possibility of major liver injury in patients with percutaneous transhepatic catheter drainage.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. ; Pancreaticobiliary Cancer Clinic, Institute of Gastroenterology, Severance Hospital, Seoul, Korea.

ABSTRACT
Postoperative pancreatic fistula (POPF) combined with postoperative fluid collection, bleeding and abscess formation is one of the most critical morbidities after distal pancreatectomy or pancreaticoduodenectomy. Percutaneous catheter drainage has been commonly used for managing for the postoperative management of abnormal fluid collection. Removal of the catheter is rarely associated with occurrence of life-threatening complication such as serious liver damage. Herein, we report a case of unexpected fatal liver injury complicated by percutaneous catheter drainage treatment after distal pancreatosplenectomy in a patient with pancreatic cancer. We suggest that prudent decision for timing of catheter removal and meticulous care during procedure can reduce the possibility of major liver injury in patients with percutaneous transhepatic catheter drainage.

No MeSH data available.


Related in: MedlinePlus

Imaging sequences of percutaneous catheter drainage-related event in a 74-year-old man who underwent distal pancreatectomy with splenectomy for pancreatic cancer. CT scan taken on postoperative day 7 shows fluid collection (arrow) around pancreatic resection margin (A). One month after discharge, CT scan shows huge fluid collection in the subhepatic area (B). After removal of the percutaneous drainage catheter, CT scan shows extensive liver laceration with massive bleeding (C). Angiography shows extravasation of the contrast agent through the hepatic artery branches of Segment 5 and 6 (arrow) (D).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4492316&req=5

Figure 1: Imaging sequences of percutaneous catheter drainage-related event in a 74-year-old man who underwent distal pancreatectomy with splenectomy for pancreatic cancer. CT scan taken on postoperative day 7 shows fluid collection (arrow) around pancreatic resection margin (A). One month after discharge, CT scan shows huge fluid collection in the subhepatic area (B). After removal of the percutaneous drainage catheter, CT scan shows extensive liver laceration with massive bleeding (C). Angiography shows extravasation of the contrast agent through the hepatic artery branches of Segment 5 and 6 (arrow) (D).

Mentions: The patient's postoperative recovery was uneventful and there was no remarkable postoperative complication. A routine postoperative follow-up imaging using abdomen CT scan was performed on postoperative day 7, in which there was free-fluid collection of 5.5×2.2 cm in size (Fig. 1A) around the pancreatic resection margin. The pathologic examination confirmed pancreatic ductal adenocarcinoma with lymph node metastasis in 7 out of 19 lymph nodes. Both lymphovascular and perineural invasion were reported. The resection margin was free from carcinoma with a 2.5-cm safety margin, but the tangential margin near the superior mesenteric artery was very close to the malignant cells. The patient discharged on postoperative day 11 without any noticeable complication.


Fatal liver injury complicated by percutaneous catheter drainage after distal pancreatosplenectomy in a patient with pancreatic cancer.

Lee SH, Kang CM, Chung YE, Park JY, Lee WJ - Korean J Hepatobiliary Pancreat Surg (2014)

Imaging sequences of percutaneous catheter drainage-related event in a 74-year-old man who underwent distal pancreatectomy with splenectomy for pancreatic cancer. CT scan taken on postoperative day 7 shows fluid collection (arrow) around pancreatic resection margin (A). One month after discharge, CT scan shows huge fluid collection in the subhepatic area (B). After removal of the percutaneous drainage catheter, CT scan shows extensive liver laceration with massive bleeding (C). Angiography shows extravasation of the contrast agent through the hepatic artery branches of Segment 5 and 6 (arrow) (D).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4492316&req=5

Figure 1: Imaging sequences of percutaneous catheter drainage-related event in a 74-year-old man who underwent distal pancreatectomy with splenectomy for pancreatic cancer. CT scan taken on postoperative day 7 shows fluid collection (arrow) around pancreatic resection margin (A). One month after discharge, CT scan shows huge fluid collection in the subhepatic area (B). After removal of the percutaneous drainage catheter, CT scan shows extensive liver laceration with massive bleeding (C). Angiography shows extravasation of the contrast agent through the hepatic artery branches of Segment 5 and 6 (arrow) (D).
Mentions: The patient's postoperative recovery was uneventful and there was no remarkable postoperative complication. A routine postoperative follow-up imaging using abdomen CT scan was performed on postoperative day 7, in which there was free-fluid collection of 5.5×2.2 cm in size (Fig. 1A) around the pancreatic resection margin. The pathologic examination confirmed pancreatic ductal adenocarcinoma with lymph node metastasis in 7 out of 19 lymph nodes. Both lymphovascular and perineural invasion were reported. The resection margin was free from carcinoma with a 2.5-cm safety margin, but the tangential margin near the superior mesenteric artery was very close to the malignant cells. The patient discharged on postoperative day 11 without any noticeable complication.

Bottom Line: Percutaneous catheter drainage has been commonly used for managing for the postoperative management of abnormal fluid collection.Removal of the catheter is rarely associated with occurrence of life-threatening complication such as serious liver damage.We suggest that prudent decision for timing of catheter removal and meticulous care during procedure can reduce the possibility of major liver injury in patients with percutaneous transhepatic catheter drainage.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. ; Pancreaticobiliary Cancer Clinic, Institute of Gastroenterology, Severance Hospital, Seoul, Korea.

ABSTRACT
Postoperative pancreatic fistula (POPF) combined with postoperative fluid collection, bleeding and abscess formation is one of the most critical morbidities after distal pancreatectomy or pancreaticoduodenectomy. Percutaneous catheter drainage has been commonly used for managing for the postoperative management of abnormal fluid collection. Removal of the catheter is rarely associated with occurrence of life-threatening complication such as serious liver damage. Herein, we report a case of unexpected fatal liver injury complicated by percutaneous catheter drainage treatment after distal pancreatosplenectomy in a patient with pancreatic cancer. We suggest that prudent decision for timing of catheter removal and meticulous care during procedure can reduce the possibility of major liver injury in patients with percutaneous transhepatic catheter drainage.

No MeSH data available.


Related in: MedlinePlus