Liver Haemangioma Resection

Sadia Ahmed 23 years old female from Chamchamal / Suleimania / Kurdistan Government Iraq. Presented with hematemesis and malena to Shorish military hospital. Recurrent in nature... (More) Sadia Ahmed 23 years old female from Chamchamal / Suleimania / Kurdistan Government Iraq. Presented with hematemesis and malena to Shorish military hospital. Recurrent in nature, moderate in amount. Receiving over all 12 pints of blood in a course of one month. Many times scoped in Baghdad and undiagnosed.
US revealed 5 cm echogenic lesion, round shape in the right lobe of the liver, deeply seated. At the time of admission she was shocked, rapid circulatory support has performed by blood transfusion and then scoped which revealed hemobilia. The procedure took 35 min.
PCV 22%
WBC 8000/ml
ESR 60mm/hr.
GUE inconclusive
BU 55 mg/dl
Serum amylase not available.
Electrolyte, cid base and blood gas not available.
Coagulation profile was not available apart from bleeding and clotting time both of which were normal.
Liver function shows mild increase in TSB 3mg/dl and mildly raised Alkaline phosphatase 17 KAU
Angiography was not available. And the CT has not been done because of the unstability of the patient's condition.
Blood group A+
Chest XR and ECG were normal .
No other investigation were available in that small hospital in hard days of
Saddam's Erra. Exploration was urgent and done by Kokher incision the bile duct has been seen dilated with greenish color. It has been explored and the blood was evacuated . Pringles maneuvers has been applied and follys catheter ball has been used to localize the site of the bleeding as the first case and the lesion has been located in the upper biliary tree. Segmental resection of the segment 6 of the liver was done depending on palpation of the firm lesion. The biliary tree has been cleaned and the duct has been closed on T- tube. She had uneventful recovery.
Discharged 10 days later. After 3 weeks of the initial surgery she had the same presentation of upper GIT bleeding, the scope again revealed hemobilia. She has been explored again after resuscitation and the firmness was extending to the wider area of the right lobe involving segment 5. The blood was coming from both ducts even after repeated wash out. Longitudinal gauze pack has been inserted repeatedly to both ducts, the result was not very conclusive because both biliary tree were full of blood and it was difficult to clear them completely. It made us in a mess. We has been obliged to do right hepatic lobectomy by thoraco-abdominal incision due to difficulties in the area made by the previous surgery.
There was no way to locate the source except by palpation. Which revealed indurations in the right lobe with almost normal consistency of the left lobe. On this base of the operative decision was right hepatic lobectomy. Fortunately she had uneventful recovery and the histopathology was consitent mostly with amoebic liver abscesse.
Date of Admission 5/9/2001
Date of Discharge 15/9/2001.

(Less)

Category:	School Work
Rating:
Upload Date:	02/09/2009
Copyright:	Attribution Non-commercial
Tags:	Presentations hatwanhospital hatwangroup drqalander kasnazani Presentations hatwanhospital hatwangroup drqalander kasnazani (fewer)

Documents

People