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.
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