Chronic biloma after right hepatectomy for stage IV hepatoblastoma managed with Roux-en-Y biliary cystenterostomy.

Abstract

We report the complex case of a 12-month-old girl with stage IV hepatoblastoma accompanied by thrombosis and cavernous transformation of the portal vein. After neoadjuvant chemotherapy, she underwent right hepatectomy, which was complicated by iatrogenic injury of her left hepatic duct, and subsequently developed a postoperative biloma and chronic biliocutaneous fistula. Concomitant with multiple percutaneous interventions to manage the biloma nonoperatively while the child completed her adjuvant chemotherapy, she progressed to develop chronic malnutrition, jaundice, and failure to thrive. Once therapy was completed and the child was deemed free of disease, she underwent exploratory laparotomy with Roux-en-Y biliary cystenterostomy for definitive management, resulting in resolution of her biliary fistula, jaundice, and marked improvement in her nutritional status. Roux-en-Y biliary cystenterostomy is a unique and efficacious management option in the highly selected patient population with chronic biliary leak refractory to minimally invasive management.

• Authors: Andrew J Murphy, Thomas P Rauth, Harold N Lovvorn 3rd
• Journal: Journal of pediatric surgery (J Pediatr Surg) Vol. 47 Issue 11 Pg. e5-9 (Nov 2012) ISSN: 1531-5037 [Electronic] United States
• PMID: 23164033 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2012 Elsevier Inc. All rights reserved.

Topics

• Anastomosis, Roux-en-Y
• Biliary Fistula (etiology, surgery)
• Chronic Disease
• Cutaneous Fistula (etiology, surgery)
• Female
• Hepatectomy (adverse effects)
• Hepatic Duct, Common (injuries, surgery)
• Hepatoblastoma (pathology, surgery)
• Humans
• Infant
• Intestine, Small (surgery)
• Liver Neoplasms (pathology, surgery)
• Neoplasm Staging
• Postoperative Complications (surgery)