search for




 

Post-cholecystectomy acute injury: What can go wrong?
Ann Hepatobiliary Pancreat Surg 2019 May;23(2):138-44
Published online May 31, 2019;  https://doi.org/10.14701/ahbps.2019.23.2.138
Copyright © 2019 Korean Association of Hepato-Biliary-Pancreatic Surgery.

Vikas Gupta1, Ashish Gupta1, Thakur Deen Yadav1, Bhagwant Rai Mittal2, Rakesh Kochhar3

Departments of 1General Surgery, 2Nuclear Medicine and 3Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Received November 22, 2018; Revised February 18, 2019; Accepted February 21, 2019.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Backgrounds/Aims: Most of the emphasis of postcholecystectomy injuries is laid on iatrogenic bilary trauma. However, they can involve a wide spectrum of injuries.
Methods: We prospectively evaluated 42 patients with postcholecystectomy injuries referred to us from July 2011 to December 2012. Based on spectrum of injuries, we proposed an algorithm of management.
Results: Injuries occurred following laparoscopy in 20 (2 converted) patients and open in 22 patients. Mean time of detection of injury was 4.32±2.33 days. The nature of drainage was bilious in 36, bile with blood in 2, only blood in 2, and enteric in 2. Nine had organ failure at presentation. Six (14%) needed re-operation. Source of hemorrhage was from right hepatic artery in three and small bowel mesentry in 1. Enteric injuries were one each to duodenum and colon. Six patient (14%) died. Advancing age and organ failure were the predictors of mortality. Persistant biliary fistula was seen in 5 (14%). Ten had lateral leaks that closed at 28.89±2.34 days. Twenty-two formed stricture which was successfully managed with definitive hepaticojejunostomy.
Conclusions: Post cholecystectomy acute injury does not limit itself to bile duct or vascular injury but it can traumatize adjacent hollow viscus or mesentery. It is important to diagnose and intervene enteric injury early. Presentation and management for such injury should be followed as per the proposed algorithm.
Keywords : Acute; Bile duct; Injury; Cholecystectomy; Vascular; Enteric; Stricture; Fistula