Iatrogenic Injury in the Lateral Segment of the Liver after Pancreatoduodenectomy: Early Follow-Up CT Features and Clinical Implications

During open surgery of the upper abdomen for treatment of an extrahepatic lesion, various iatrogenic insults to the liver are possible. Other than unintentional parenchymal laceration or bile duct injury, there have been some reports of localized hypoxic injuries which were supposed to be related to the parenchymal compression by surgical retractor with or without the presence of major vascular injury supplying the hepatic segment during the surgical procedure (1-4). Because of the dual blood supply and potentially extensive collateral pathways in the liver, focal hepatic ischemic injury is a rare condition (5). Only a few reports have dealt with the imaging findings of hepatic ischemic injuries caused by vascular insufficiency or low attenuation ischemic lesions of the liver with various shapes and locations on contrast-enhanced computed tomography (CT). The shapes can be round, oval or wedge-shaped with sharp or poor margins and can be located in the peripheral or central portions of the hepatic parenchyma (6-8). Because of the nonspecific imaging findings, focal hepatic ischemia could be confused with a newly developed tumorous condition. Even on early follow-up CT after surgery, the Original Article