Intraoperative Color Doppler assessment of hepatic vasculature integrity: A Case Report

Abstract

Background: Color Doppler is an important, noninvasive, non-ionizing imaging modality for assessment of vascular system of most parts of the body "Neck, limbs, hepatic vasculature …. etc.". It is commonly used to assess patient either before medical or surgical treatment but less common to be used intraoperative. Color Doppler assessment of hepatic vasculature in the daily work is commonly used to assess patency of portal vein and hepatic artery and to assess the hemodynamics of hepatic blood flow. Intraoperative assessment of hepatic vasculature integrity is not a common use of Doppler. It can help the surgeon to complete his operation on the usual steps with confirming non injury of hepatic vasculature. Case Report: We present a case who presented to Sohag University Hospital outpatients clinics by repeated right hypochondrial pain. Ultrasound was done and revealed that he has chronic calcular cholecystitis with a stone obstructing cystic duct the surgeon decided to do cholecystectomy. During the operation a sudden profuse bleeding at the site of hepatic hilum occurs, the surgeon doubt that a major vessel "Hepatic artery or portal vein was injured ", so he asked for urgent color Doppler assessment of hepatic vasculature integrity. Conclusion: Color Doppler examination is an important tool for assessment of vascular system of different organs including liver. It can be used intraoperatively to confirm integrity of blood vessels and exclusion occurrence of iatrogenic complication during the operation itself, guiding the surgeon to make a suitable decision during the same setting and avoiding re-exploration of the patient.