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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