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Management of major bile duct injury after laparoscopic cholecystectomy: a case report

Andreas Manouras1, Nikolaos Pararas1, Pantelis Antonakis1, Emannuel E Lagoudiannakis2*, George Papageorgiou3, Ioannis G Dalianoudis2 and Manoussos M Konstadoulakis1

Author Affiliations

1 1st Department of Propaedeutic Surgery, Hippocrateion Hospital, Athens Medical School, University of Athens, Athens, Greece

2 Second Department of Surgery, 417NIMTS, Athens, Greece

3 Endoscopic Radiology Department, Naval Hospital of Athens, Athens, Greece

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Journal of Medical Case Reports 2009, 3:44  doi:10.1186/1752-1947-3-44

Published: 31 January 2009

Abstract

Introduction

Bile duct injury is a severe and potentially life-threatening complication of laparoscopic cholecystectomy. Several series have described a 0.5% to 0.6% incidence of bile duct injury during laparoscopic cholecystectomy. The aim of this study was to analyze the presentation, characteristics, related investigation, and treatment results of major bile duct injuries after laparoscopic cholecystectomy.

Case presentation

A rare case of a 48-year-old Greek woman with a triple bile duct injury (right and left hepatic duct ligation and common bile duct cross-section) is presented. A Roux en Y hepaticojejunostomy was performed after repeated endoscopic retrograde cholangiopancreatographies, percutaneous transhepatic catheterization of the ducts and magnetic resonance cholangiographies to delineate the biliary anatomy and assess the level of injury.

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 and skilled interventional radiologists would appear to be necessary to assure optimal results.