1Almamoon Justaniah,1Zergham Zia, 1Zergham Zia, 1Majed Ashour
1King Faisal Specialist Hospital & Research Center
IBile duct injuries during laparoscopic cholecystectomy are associated with increased mortality and morbidity. Management requires a multidisciplinary approach to decrease further complications and improve quality of life. We present a case of common hepatic duct (CHD) injury due to laparoscopic cholecystectomy managed by extra-anatomic internal-external biliary drainage catheters.
Material(s) and Method(s):
An 85-year-old male presented to an outside hospital with acute cholecystitis. A laparoscopic cholecystectomy was attempted and complicated by CHD injury. The surgery was converted to an open cholecystectomy however, the injury was not repaired. The patient was transferred to our institution to manage his biliary leak. A multidisciplinary team meeting was conducted with a consensus to proceed with drainage of biloma, percutaneous transhepatic cholangiogram (PTC) to assess the injury and percutaneous transhepatic biliary drains (PTBDs).
The patient was vitally stable with no leukocytosis or hyperbilirubinemia. Magnetic resonance imaging demonstrated a 4×5 cm collection at the porta hepatis and a right subhepatic collection measuring 5×7 cm. The intrahepatic bile ducts were nondilated. PTC under general anesthesia demonstrated CHD injury with contrast extravasation at the confluence, with involvement of the right and left main ducts. Bilateral PTBDs were advanced from the hepatic ducts to the duodenum through the porta hepatis collection and duodenal defect. Passing the catheters through the common bile duct (CBD) could not be achieved due to near complete separation of the CHD from the CBD. Drains were placed in the collections and removed after 2 weeks. The PTBDs were open to bag for one week, then capped with routine exchanges in the last 5 months.
Interventional Radiology plays an important role in the management of bile duct injuries when patients are inoperable or when the defect is large.