Bile Duct Injury

Clinical features:

  • – Abdominal pain: diffuse, localized
  • – Nausea, anorexia, abdominal distension due to ileus
  • – Clinically apparent ascites, bile peritonitis      Less common
  • – Investigations: abdominal USG (Assess abd.fluid collection, abnormalities in biliary tree e.g. focal dilation), Radionuclide biliary scintigraphy to assess ongoing leakage, HIDA scanning

Causes of bile duct injury:

  • – Aberrant anatomy
  • – Inadequate exposure
  • – Other biliary surgery
  • – Liver biopsy
  • – Penetrating/blunt abdominal trauma
  • – Rarely, spontaneous perforation

Risk Factors for bile duct injury:

  • – Impacted cystic duct stone
  • – Mirizzi’s syndrome
  • – Impacted stone in hartmann’s pouch of gall bladder
  • – Inflammatory alteration
  • – Anatomical anomalies of intrahepatic ducts

 

Amsterdam/Bergman classification of bile duct injury:

 

  • – Type A: Cystic duct/ aberrant bile duct leakage
  • – Type B: CBD leakage, with/without stricture
  • – Type C: CBD stricture without leakage
  • – Type D: Complete CBD transection with/ without tissue loss

 

Treatment of bile duct injury identified intraoperatively:

  • – Primary surgical repair for type A, B, C injury if surgical expertise available. For type D lesions: intra operative consultation with expert centre, merely subhepatic drainage is advised and the patient is referred to expert centre. Late reconstruction (after 6-8 weeks) is advised often with hepatico-jejunostomy

Treatment of bile duct injury diagnosed postoperatively

  • – Type A, B, C injury ERCP with stenting
  • – Type D injury Late reconstruction

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