Papers of the Week

When the entire hepatic pedicle is invaded by a tumour, the treatment of cholestasis represents a challenge both for choosing the best drainage possibility and for performing the liver haemostasis during a surgical procedure. Case Report: A patient with progressive jaundice resulting from a remaining gastric tumour that invaded the gallbladder and the hepatic pedicle was successfully treated with biliary decompression using the omega hepaticojejunal shunt. The minor parenchymal bleeding was achieved with the electrocautery greased with lidocaine gel. When burned by the electrocautery, the lidocaine gel made a sealing crust that recovered all the liver parenchyma. Efficacious and stable haemostasis was immediately achieved. The patient had an uneventful early postoperative follow-up, and all cholestasis manifestations, including jaundice and pruritus, decreased since the first day. The patient survived nine months with asymptomatic low jaundice. Conclusion: In the presence of general involvement of the bile ducts, the omega hepaticojejunal shunt reduces the manifestations of cholestasis and improves the patient's quality of life. The electrocautery greased with lidocaine gel is inexpensive, easily available and efficacious method to achieve immediate hepatic haemostasis.