Rupture of the Right Hepatic Artery After Left Lobectomy of the Liver in Patients with Bile Duct Carcinoma

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Transcatheter arterial embolization (TAE) has been reported as the treatment of choice for rupture of the visceral artery. We experienced two clinical cases of rupture of the right hepatic artery after left lobectomy of the liver for radical resection of the bile duct carcinoma. In the first case, TAE was performed on the right hepatic artery twice under a condition of hemorrhagic shock. Consequently, hepatic ischemia developed into complete infarction of the remnant liver tissue in spite of control of bleeding from the rupture site. In the second case, TAE was successfully accomplished because of the patient's good general condition and sufficient collaterals to the remnant liver. Bile leakage from the hepaticojejunostomy was observed early in the postoperative course, and episodes of intermittent flow of blood through the abdominal drain were experienced in both cases. Injury to the exposed arterial wall by leaking bile after lymph-node dissection was considered to be a possible contributive factor of rupture. TAE following initial diagnostic arteriography should be performed at an early stage when there are several episodes of intraabdominal bleeding. However, hypovolemic shock from massive hemorrhage and poor arterial collaterals due to the primary surgical procedure unfavorably affected the prognosis of a patient undergoing TAE.
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