Case Report: Right Hemihepatectomy En-bloc with Caudate Lobectomy for Klatskin Bismuth Type 3a in a Patient with Right Portal Vein Thrombosis and Right Hemiliver Inflammatory Pseudotumors

We present the case of a 69-year old female patient with a history of multiple abdominal surgical interventions, that was investigated in another unit for jaundice, severe angiocholitis with septic shock. MRI and CT scan revealed a Klatskin Bismuth 3a tumor with right lobe lesions which were initially interpreted as secondary malignant lesions . The patient was treated in the ICU department with excellent response after intensive conservative treatment. An ultrasound guided biopsy from the right liver lesions was performed witch revealed the inflammatory pseudotumoral nature of the lesions, most probably these lesions were liver abscesses that responded to antibiotic therapy. The patient was referred in our department for surgery. A CT scan was performed and revealed a right portal vein thrombosis.

A right hemi-hepatectomy en-bloc with caudate lobectomy was performed.  The postoperative course was uneventful, the final pathologic examination revealed a moderately differentiated perihillar cholangiocarcinoma pT1pN0 R0 . No adjuvant treatment was planned. 

* Case was presented as an e-poster at Nation Conference of Surgery, Romania, EforieNord May 2023