Biliary sunrise - bile color as visible sign for hepatic ischemia after iatrogenic partial liver de-arterialization: A case report

Figure 1 Contrast-enhanced computed tomography demonstrating delayed enhancement of the right hepatic lobe during the arterial phase and occlusion of the right hepatic artery.

Figure 2 Intraoperative findings demonstrating iatrogenic transection and clipping of the main hepatic duct and right hepatic artery.

Figure 3 Operative reconstruction. A: Intraoperative drain placement into the right posterolateral, right anteromedial and left bile duct; B: Percutaneous transfixed drains with external drainage.

Figure 4 The “biliary sunrise”. (Figure 4B was created by Adrian Stelzl using a professional graphic illustration software - Affinity Designer). A: Extracted bile demonstrating a gradient of biliary pigmentation from more ischemic to less ischemic liver regions. From left to right: 1: Right posterolateral duct; 2: Right anteromedial duct; 3: Left bile duct; B: Schematic illustration of Neuhaus drain positioning within the partially ischemic liver.