This journal is
indexed in Scopus
Year 2018 Vol. 26 No 6
O.I. OKHOTNIKOV 1, 2, M.V. YAKOVLEVA 1, 2, O.S. GORBACHEVA 1, 2
IATROGENIC DAMAGE OF THE COMMON HEPATIC DUCT DURING LAPAROSCOPIC CHOLECYSTECTOMY, COMPLICATED BY FORMATION OF THE RIGHT-SIDED RETROPERITONEAL BILOMA
Kursk Regional Clinical Hospital 1,
Kursk State Medical University 2, Êursk,
The Russian Federation
The article presents the clinical observation of the diagnosis and treatment of the patient with iatrogenic damage of the common hepatic duct during the performance of video laparoscopic cholecystectomy without traditional clinical and laboratory signs of biliary iatrogenia using methods of minimally invasive x-ray surgery.
The results of the successive application of diagnostic puncture and drainage under the US-control of separated bile accumulations of the right retroperitoneal space and the pelvic cavity, antegrade cholangiography on the unexpanded ducts, revealed the intersection of the common hepatic duct with its partial clipping and transformed into percutaneous transhepatic cholangiostomy are shown. Subsequently, cholangiostomy drainage was intraoperatively transformed into external-internal biliary drainage, performed for biliodigestive anastomosis when hepaticoenterostomy was performed on the R-loop of the small intestine.
Iatrogenic damage of the bile ducts, not accompanied by concomitant disturbance of the bile outflow, can be difficult for timely diagnosis if the formation of the bile accumulation is retroperitoneal. Thus, ultrasound monitoring of patients undergoing video-laparoscopic cholecystectomy should be considered as a necessary routine instrumental examination, which allows detecting possible iatrogenic complications in time, including those not accompanied by traditional clinical and laboratory manifestations. Antegrade X-ray external surgical drainage of the biliary tree is an effective primary minimally invasive adjuvant intervention in relation to reconstructive surgery - gepaticojejunostomy.
- Gould L, Patel A. Ultrasound detection of extrahepatic encapsulated bile: “biloma”. AJR Am J Roentgenol. 1979 Jun;132(6):1014-15. doi: 10.2214/ajr.132.6.1014
- Tani C, Nosaka S, Masaki H, Kuroda T, Honna T. Spontaneous perforation of choledochal cyst: a case with unusual distribution of fluid in the retroperitoneal space. Pediatr Radiol. 2009 Jun;39(6):629-31. doi: 10.1007/s00247-009-1189-6
- Yaşar NF, Yaşar B, Kebapç? M. Spontaneous common bile duct perforation due to chronic pancreatitis, presenting as a huge cystic retroperitoneal mass: a case report. Cases J. 2009 Sep 8;2:6273. doi: 10.4076/1757-1626-2-6273
- čólović R, Perisić-Savić M. Retroperitoneal biloma secondary to operative common bile duct injury. HPB Surg. 1991;3(3):193-97. doi: 10.1155/1991/39181
- Lim DZ, Wong E, Hassen S, Al-Habbal Y. Retroperitoneal bile leak after laparoscopic cholecystectomy. BMJ Case Rep. 2018 Jan 18;2018. pii: bcr-2017-222750. doi: 10.1136/bcr-2017-222750
- Lee Y, Roh Y, Kim M, Kim Y, Kim K, Kang S, Jang E. Analysis of post-operative complication in single-port laparoscopic cholecystectomy: A retrospective analysis in 817 cases from a surgeon. J Minim Access Surg. 2018 Jan 10. doi: 10.4103/jmas.JMAS_168_17.
- Conrad C, Wakabayashi G, Asbun HJ, Dallemagne B, Demartines N, Diana M, Fuks D, Giménez ME, Goumard C, Kaneko H, Memeo R, Resende A, Scatton O, Schneck AS, Soubrane O, Tanabe M, van den Bos J, Weiss H, Yamamoto M, Marescaux J, Pessaux P. IRCAD recommendation on safe laparoscopic cholecystectomy. J Hepatobiliary Pancreat Sci. 2017 Nov;24(11):603-615. doi: 10.1002/jhbp.491
- Chun K. Recent classifications of the common bile duct injury. Korean J Hepatobiliary Pancreat Surg. 2014 Aug;18(3):69-72. doi: 10.14701/kjhbps.2014.18.3.69
- Iwashita Y, Hibi T, Ohyama T, Umezawa A, Takada T, Strasberg SM, Asbun HJ, Pitt HA, Han HS, Hwang TL, Suzuki K, Yoon YS, Choi IS, Yoon DS, Huang WS, Yoshida M, Wakabayashi G, Miura F, Okamoto K, Endo I, de Santibañes E, Giménez ME, Windsor JA, Garden OJ, Gouma DJ, Cherqui D, Belli G, Dervenis C, Deziel DJ, Jonas E, Jagannath P, Supe AN, Singh H, Liau KH, Chen XP, Chan ACW, Lau WY, Fan ST, Chen MF, Kim MH, Honda G, Sugioka A, Asai K, Wada K, Mori Y, Higuchi R, Misawa T, Watanabe M, Matsumura N, Rikiyama T, Sata N, Kano N, Tokumura H, Kimura T, Kitano S, Inomata M, Hirata K, Sumiyama Y, Inui K, Yamamoto M. Delphi consensus on bile duct injuries during laparoscopic cholecystectomy: an evolutionary cul-de-sac or the birth pangs of a new technical framework? J Hepatobiliary Pancreat Sci. 2017 Nov;24(11):591-602. doi: 10.1002/jhbp.503
- Kapoor VK. Bile duct injury repair: when? what? who? J Hepatobiliary Pancreat Surg. 2007;14(5):476-79. doi: 10.1007/s00534-007-1220-y
- Fong ZV, Pitt HA, Strasberg SM, Loehrer AP, Sicklick JK, Talamini MA, Lillemoe KD, Chang DC. Diminished survival in patients with bile leak and ductal injury: management strategy and outcomes. J Am Coll Surg. 2018 Jan 4. pii: S1072-7515(17)32186-5. doi: 10.1016/j.jamcollsurg.2017.12.023.
- Panchenkov DN. Mamalygina LA. Iatrogennye povrezhdeniia vnepechenochnykh zhelchnykh protokov: diagnostika i khirurgicheskaia taktika na sovremennom etape. Annaly Khirurg Gepatologii. 2004;9(1):156-63. http://hepatoassociation.ru/ASH/Volumes/Pdf91/PanMam91.pdf (in Russ)
- Okhotnikov OI, Yakovleva MV, Gorbacheva OS, Pakhomov VI. Using of a coated self-expanding endobiliary stent for temporary restoration of biliary tract after iatrogenic injury. Annaly Khirurg Gepatologii. 2017;22(3):87-93. doi: 10.16931/1995-5464.2017387-92 (in Russ.)
- Korobkin M, Silverman PM, Quint LE, Francis IR. CT of the Extraperitoneal Spase: normal anatomy and fluid collections. AJR Am J Roentgenol. 1992 Nov; 159(5): 933-42. doi: 10.2214/ajr.159.5.1414803
- Mindell HJ, Mastromatteo JF, Dickey KW, Sturtevant NV, Shuman WP, Oliver CL, Leister KL, Barth RA. Anatomic communications between the three retroperitoneal spaces: determination by CT-guided injections of contrast material in cadavers. AJR Am J Roentgenol. 1995 May;164(5):1173-78. doi: 10.2214/ajr.164.5.7717227
305047, The Russian Federation,
Kursk, Sumskaya Str., 45à,
Kursk Regional Clinical Hospital,
Department of X-ray Surgical
Diagnostic and Treatment Methods ¹ 2,
Tel.: +7 910 740 20 92,
Oleg I. Okhotnikov
Okhotnikov Oleg, MD, Professor, Head of the Department of X-ray Surgical Diagnostic and Treatment Methods ¹ 2, Kursk Regional Clinical Hospital, Professor of the Department of Radiation Diagnostics and Therapy, Kursk State Medical University, Kursk, Russian Federation.
Yakovleva Marina, PhD, Associate Professor of the Department of Surgical Diseases of the Faculty of Post-Graduate Education, Kursk State Medical University, Physician of the Department of X-ray Surgical Diagnostic and Treatment Methods ¹ 2, Kursk Regional Clinical Hospital, Kursk, Russian Federation.
Gorbacheva Olga, PhD, Head of the Department of General Surgery, Kursk Regional Clinical Hospital, Assistant of the Department of Surgical Diseases of the Faculty of Post-Graduate Education, Kursk State Medical University, Kursk, Russian Federation.