Novosti
Khirurgii

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Year 2018 Vol. 26 No 6

CASE REPORTS

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.

Keywords: laparoscopic cholecystectomy, iatrogenic damage of bile ducts, ultrasound examination, biloma of retroperitoneal space, antegrade transhepatic cholangiostomy
p. 765-771 of the original issue
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Address for correspondence:
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,
e-mail oleg_okhotnikov@mail.ru,
Oleg I. Okhotnikov
Information about the authors:
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.
http://orcid.org/0000-0002-6685-3183
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.
http://orcid.org/0000-0003-3452-6652
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.
http://orcid.org/0000-0002-6642-1743
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