Presentation and Management of Extra Hepatic Bile Duct Injuries

Abstract

Objective: To present the experience of presentation and management of extra hepatic bile duct injuries at a tertiary care unit of a teaching hospital. Design: A descriptive & observational case study. Place and Duration of Study: South Surgical Unit, Mayo Hospital, Lahore from June 1999 to 2004. Subjects and Methods: A total number of 15 patients 6 male and 9 female, with history of cholecystectomies presenting with biliary peritonitis or obstructive jaundice were included in the study. Their nodes of presentation and the operative management with outcomes were noted. Results: These were 6 male and 9 female patients with CBD injuries, the age ranged between 12 & 55 years. Sic of them had laparoscopic cholecystectomies while nine had open procedures. Majority of them were referrals, mode of presentation was jaundice in 7 cases while 8 of them presented with jaundice, sepsis and peritonitis. Nine has Roun-en-Y hepaticojejunostomy, one loop HJ, 2 T-tube repairs, a cholecystojejunostomy and an ERCP stenting was done. One patient expired before any procedure could be done and another expired post operatively, rest of them showed delayed but good recovery. Conclusion: Damage to CBD is a serious complication. It is best avoided by adequate training, good exposure and knowledgeable dissection, difficult anatomy and unexpected bleeding are the most common aetiological factors. The gold standard for treatment is early intervention and a Roux-en-Y Hepaticojejunostomy and an early referral to centres where expertise is available as successive attempts by less experienced surgeons result in diminished returns.