Recently, the Fifth Affiliated Hospital of Jinan University, Shenhe People's Hospital (hereinafter referred to as "Shenhe People's Hospital") jointly consulted and successfully diagnosed and treated the first case of posthepatic ectopic "bile lake" in Heyuan .
66-year-old male patient Xu has been repeatedly suffering from abdominal pain for half a year. He has visited many hospitals and was diagnosed with " gastric disease ". He was treated with inhibiting gastric acid . The symptoms are sometimes better and sometimes worse, and the abdominal pain has not been eradicated. This time, I went to Shenhe People's Hospital for treatment due to skin, sclera yellowing, 2 and half a month, accompanied by 38℃ fever, nausea, vomiting, and unbearable upper abdominal pain.
patient underwent an upper abdomen 3.0 MRI examination after admission. The images showed multiple liver abscesses and acute cholangitis . However, the doctor was stumped by this posthepatic cystic lesion and could not be judged from the image as liver abscess or cyst. Zeng Junjie, director of the imaging department of
, carefully reviewed the images and found that a slender rat caudate tubule leads to the vicinity of the liver hilar foci. Only the original thin layer data in MRCP can be clearly displayed. Combined with the patient's common bile duct excision and cholecystectomy history, it was decisively pointed out that the posthepatic cystic foci was "bile lake". After joint consultation between experts in gastroenterology and hepatobiliary surgery, he was finally diagnosed as bile lake. The patient's repeated upper abdominal pain is caused by this lesion and requires surgical drainage treatment.
According to Liu Xiongyou, director of the Department of Hepatobiliary Surgery, the "rare" in this case lies in the location of the lesion. Bile Lake, also known as cholesteatoma, is a cyst formed by the overflow of bile ducts after rupture, wrapping and fibrosis of . Bile Lake is a serious complication after hepatobiliary surgery, intervention, or hepatobiliary trauma, and usually occurs in the hepatobiliary trauma or surgical site. The patient Xu's bile lake unexpectedly appeared behind the liver away from the original surgical site, and the patient did not experience upper abdominal pain or fever symptoms recently after the operation, which led to misdiagnosis by many hospitals before. Therefore, a more comprehensive analysis is required during diagnosis to obtain a correct diagnosis.
"Considering that the patient had biliary surgery before, and this intraabdominal lesions are considered related to his biliary surgery, I guess there may be serious adhesions in the abdominal cavity. From the image, the lesions are located between the inferior vena cava, the abdominal aorta, the portal vein of , and the caudal lobe of the liver. It is difficult to dissect. Whether it is open or laparoscopic surgery, the operation must be difficult." Liu Xiongyou introduced, "So, I repeatedly discussed the lesion site and surgical approach before the operation, fully considered various possible situations, and decided to use laparoscopic surgery."
It is reported that the operation was successfully completed, and the cystic lesions were completely removed, leading to internal bile. The patient recovered well after the operation, and the follow-up examination showed that the bile lake had completely disappeared and he was discharged from the hospital successfully.
[Written by] Guo Yuhuan
[Author] Guo Yuhuan
[Source] Southern Media Group Southern + Client
