# Segmental hepatic necrosis following embolization for delayed hemorrhage after laparoscopic pancreaticoduodenectomy: a case report

## TL;DR

A rare case of liver tissue death after a blood vessel blockage procedure to treat post-surgery bleeding highlights the need for careful pre-surgery planning.

## Contribution

This case report highlights the rare complication of hepatic necrosis following embolization for post-pancreaticoduodenectomy hemorrhage.

## Key findings

- Hepatic lobe necrosis occurred 40 days after embolization for post-surgery bleeding.
- The necrotic tissue spontaneously discharged from the surgical wound and was confirmed by histopathology.
- The left hepatic lobe's lack of collateral blood flow likely caused the ischemic injury.

## Abstract

Postpancreaticoduodenectomy hemorrhage (PPH) is a serious complication of laparoscopic pancreaticoduodenectomy (LPD); however, hepatic lobe necrosis secondary to transarterial embolization for this condition is exceedingly rare. To our knowledge, this complication has been sparsely documented, with previous reports predominantly focusing on treatment modality selection for PPH rather than on post-embolization hepatic necrosis. We report a case of late intra-abdominal hemorrhage after LPD, which was treated with common hepatic artery embolization under digital subtraction angiography (DSA). Forty days after embolization, necrotic tissue was spontaneously discharged from the laparotomy wound, and histopathology revealed devitalized liver parenchyma. The patient recovered well with conservative wound care, drainage, and irrigation. Hepatic necrosis following embolization for PPH may result from the left lobe’s paucity of collaterals, which leads to insufficient perfusion and renders it more vulnerable to ischemic injury. This case underscores the critical importance of preoperative imaging and surgical planning in LPD. Preoperative imaging enables precise delineation of hepatic vascular anatomy, facilitating comprehensive surgical planning to maximize preservation of major vessels and enabling informed decision-making even when managing PPH.