After hepatectomy white test is potential trigger of acute pancreatitis: Case Study

Acute pancreatitis (AP) after liver resection is a rare but serious complication, and few cases have been described in the literature. Extended lymphadenectomy and long ischemia due to the Pringle manoeuvre could be responsible of post-liver resection acute pancreatitis, but the exact causes of Acute pancreatitis (AP) after hepatectomy remain unclear.

The researchers reported three cases of Acute pancreatitis (AP) after hepatectomy and we strongly hypothesize that this is due to the bile leakage white test. 502 hepatectomy were performed at our centre and 3 patients (0.6%) experienced acute pancreatitis after LR and all of these three patients underwent the white test at the end of the liver resection. None underwent additionally lymphadenectomy to the liver resection. All patients had a white test during the liver surgery.

Patient A, was a 72-year-old man, underwent a bisegmentectomy V–VI for hepatocellular carcinoma on NASH in November 2020. His comorbidities were high blood pressure, diabetes mellitus, and atrial fibrillation under treatments of anticoagulants.

Patient B, a 66-year-old man, who underwent right hepatectomy in January 2017 for HCC on F2 liver fibrosis post hepatitis C infection experienced post liver resection pancreatitis. A review of this case showed the white test as the trigger factor of pancreatitis.

Patient C, a 65-years-old man, with high blood pressure, hypercholesterolemia, and chronic alcohol consumption comorbidities underwent posterior sectoriectomy for HCC in October 2017. A preoperative blood test showed: platelets: 160 G/L, Prothrombin time: 100%, AFP: 8.1 ng/mL, and normal liver test.

Results of the study:

The researchers identified distal implantation of the cystic duct in these three patients as a potential cause for acute pancreatitis.

Thus, the researchers concluded that the white test is useful for detection of bile leakage after liver resection, but we do not recommend a systematic use after LR, because severe acute pancreatitis can be lethal for the patient, especially in the case of distal cystic implantation which may facilitate reflux in the main pancreatic duct.

Reference:

A study titled, "The white test for intraoperative screening of bile leakage: a potential trigger factor for acute pancreatitis after liver resection—a case series" by Chopinet S et. al published in the BMC Surgery.

https://doi.org/10.1186/s12893-021-01354-5