ABSTRACT
Objective To study the effectiveness of different treatment modalities for iatrogenic injury of distal common bile duct during operation.Methods We browsed Chinese Medical Full-text Data-base with the term of “distal common bile duct injury”.All the clinical studies associated with perioperative latrogenic injury of distal common bile duct and adjacent tissue published after 1990 were enrolled,and we collected the clinical data,mortality and reoperation rate with different treatments for analysis.Results Thirty-four case series and case reports with 233 patients were included.14 patients with isolated duodenal injury were excluded.The overall mortality of the remaining 219 patients was 9.6％,and the reoperation rate was 17.4％.A total of 145 patients who were diagnosed with distal common bile duct injury during and after operation from 21 articles were compared.The mortality and reoperation rate were both 1.9％ among 106 patients who were diagnosed during operation.The figures were 43.6％,and 84.6％ among 39 patients who were diagnosed after operation,respectively.In 9 articles with 46 patients,the clinical outcomes of 21 patients who were treated by intraoperative suture was compared with 25 patients who underwent enhanced biliary and retroperitoneal drainage.The mortality and reoperation rates were 0 in both groups.Conclusions Early detection and management are crucial to perioperative common bile duct injury.Furthermore,no significant difference of clinical outcomes observed between bile drainage and perforation suture groups.
ABSTRACT
Traumatic injury to extrahepatic bile duct system is a rare entity. Associated injuries are usually the indication of surgical exploration, and most of the common bile duct (CBD) injuries are diagnosed intraoperatively. Here, we present a case of a 23-year-old boy with a history of road traffic accident. Intraoperatively there was moderate hemoperitoneum with Grade 3 liver laceration, Grade 1 splenic laceration, laceration of anterior wall of stomach, common hepatic artery tear, and complete transaction of CBD. The principle of damage control surgery followed. Stomach laceration repaired and common hepatic artery ligated. Infant feeding tube placed in a proximal portion of transected CBD and distal portion ligated. The patient was discharged on the 45th day with infant feeding tube draining bile. In follow-up OPD tube cholangiogram followed by magnetic resonance cholangiopancreatography done which showed the formation of a choledochoduodenal fistula. Infant feeding tube removed. The patient did well for next 6 months but after that he presented with jaundice which on evaluation found to be due to stricture of choledochoduodenal fistula. The patient underwent elective cholecystojejunostomy. Miraculous spontaneous formation of choledochoduodenal fistula in traumatic CBD injury and management by cholecystojejunostomy is very less reported in the literature.
ABSTRACT
Objective To promote the recognition and effect of treatment of the iatrogenic injury in the end of common bile.Methods The clinical data of 12 cases of the iatrogenic injury in the end of common bile duct were retrospectively analyzed.Of the 12 patients with an age ranging from 45-65,6were mate and 6 female.All the 12 patients had the bile leakage after choledocholithotomy in combination with exploration.The injury was found during operation and managed immediately in 6 cases.In other 6 cases,there were fever and right upper local retroperitonitits and delayed diagnosis of the injury.Results Nine cases were cured and 3 died(mortality=25%).Conclusion Timely finding and management of the injury during operation are important.Meanwhile,postoperative finding and early management can promote the survival of patients.The delayed treatment will result in high mortality.