Bile duct injury :

Bile duct injury is a severe and potentially life-threatening condition. The most common cause of bile duct injury is the accidental trauma to the bile duct during laparoscopic / open cholecystectomy . It is estimated that as many as 1% of gallbladder operations may lead to injury to the bile duct. About 0.5% to 0.6% incidence of bile duct injury during laparoscopic cholecystectomy. The other causes are accidental injury during gastric, duodenal, colonic, pancreatic or liver surgery.

Abdominal blunt or penetrating injury may also cause bile duct injury but rare.

Patients with bile duct injury may experience symptoms soon after surgery, or several weeks to months after the injury has occurred. Early onset of symptoms, usually present with leakage of bile into the abdominal cavity, this include: Persistent pain, nausea and/or vomiting, fever and Jaundice and septicemia.

Accidental Clipping/ligation of bile duct for long time may lead to biliary obstruction, heptic failure, coagulation disorder and renal failure .Delayed effect of biliary obstruction is the biliary stricture (narrowing) of bile duct, so that bile cannot pass through. If this obstruction persists for longer period then causes cholestatic jaundice and finally secondary biliary cirrhosis.

 

 

Multiple factors are involved in causation of injury. The common factors are developmental anomaly of biliary system, unclear anatomy of the region, severe inflammation and technical difficulties.

 

 

 

 

Evaluation needs proper history , liver function, coagulation and renal functional profile, Imaging like abdominal ultrasound, ERCP and MRCP to definite the site and extend of injury. Special emphasis is given to evaluate injury of other structures like vascular and bowel.

Treatment is the restoration hepato enteric bile flow. Endoscopic procedure as ERCP is perfomed for evaluation and stenting the injured site. The surgical procedure depends on the grade and associated injury. The common practice of restoration of bile flow from liver to intestine by is Roux en Y hepaticojejunostomy (Biliary reconstruction)

Conclusion

Early recognition and an adequate multidisciplinary approach are the cornerstones for the optimal final outcome. Suboptimal management of injuries often leads to more extensive damage to the biliary tree and its vasculature. Early referral to a tertiary care center with experienced Hepatobiliary surgeons would appear to be necessary to assure optimal results.

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