Bile Duct Injuries

BILE DUCT INJURIES

• Cholecystectomy (Lap cholecystectomy associated with higher % of injuries) [lap cholecystectomy – upper 3rd  injured, open cholecystectomy – middle 3rdinjured]
• Instrumentation(ERCP, Choledoscope)
• Anatomical variations
• Surgeons inexperience
• Local pathology: Acute inflammation, Shrunken gall bladder, Mirrizi syndrome, Moynihans hump

 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