BILE DUCT INJURIES

BILE DUCT INJURIES


BILE DUCT INJURIES

  • Cholecystectomy (Lap cholecystectomy associated with higher % of injuries) lap cholecystectomy – upper 3rd  injured, open cholecystectomy – middle 3rd injured
  • Instrumentation(ERCP, Choledoscope)
  • Anatomical variations
  • Surgeons inexperience
  • Local pathology: Acute inflammation, Shrunken gall bladder, Mirrizi syndrome, Moynihans hump 
Classifications of Bile duct injury-
I) Bismuth classification of bile duct strictures- 


II) Strasberg classification of bile duct injury-

Clinical features:

  • Presenting with abdominal pain, distension, cholangitis, sepsis, ileus, jaundice, excessive bile from drain – think of bile duct injury 

Investigations:

  • USG- first investigation to confirm
  • CT SCAN- more sensitive in confirming leaks and collections
  • Biliary Scintigraphy– diagnosis leak but not the site
  • ERCP- diagnosis leak but not delineates intrahepatic ductal anatomy in presence of CBD or hepatic duct disruption
  • MRCP – best to decide therapeutic approach 

Management:

  • Early repair not attempted. only drainage procedures carried out
  • Ideal time of repair is 8 to 12 weeks to allow inflammation to subside
  • Roux-en-Y -hepatico-jejunostomy

Exam Important

Management:

  • Early repair not attempted. only drainage procedures carried out
  • Ideal time of repair is 8 to 12 weeks to allow inflammation to subside
  • Roux-en-Y -hepatico-jejunostomy
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