肝門部領域胆管癌術後の難治性細胆管炎に起因すると思われる肝不全に対し 抗菌薬動注療法が奏効した1 例

We present a 65-year-old man who underwent left hepatic trisegmentectomy and biliary reconstruction for hilar cholangiocarcinoma. Four months after the operation, serum total bilirubin level was elevated to 24.1 mg/dl. CT revealed a migrated biliary stent in the intrahepatic bile duct. The stent was successfully removed under percutaneous transhepatic approach; however, serum total bilirubin level did not decreased. The diagnosis of liver failure caused by refractory cholangitis was made and, intra-arterial antibiotic therapy using meropenem and ciprofloxacin was performed, and thereafter, the serum total bilirubin promptly decreased. This case report suggests that intra-arterial antibiotic therapy seems to be effective for liver failure caused by refractory cholangitis after major hepatectomy with biliary reconstruction.