RESUMO
Bile duct injury following cholecystectomy is an uncommon but challenging clinical condition. The aim of this work was to analyze clinical presentations, evaluate different diagnostic procedures and to assess the outcome of surgery. During the period from January 2001 till the end of May 2003, 28 patients with a post cholecystectomy bile duct injury [presented either early 21 patients or late 7 patients] were included in the study. They were 21 females and seven males. Their age ranged between 29 and 66 years. All patients were evaluated clinically and biochemically. To assess the site and extent of injury ultrasonography, direct cholangiography and / or MRCP were done for all patients. Computed tomography was done when needed. In this work, complete bile duct ligation with early onset of progressive jaundice represented the majority of patients who presented early [47.6%]. When the ligation or clipping was distal to the cystic duct insertion a biliary fistula also developed [4.8%]. Injury with subsequent bile leakage [fistula, biloma or diffuse peritonitis] and later stricture formations were the other presentation in this group [47.6%]. Jaundice and cholangitis were the main presentation in patient who presented late. The majority of patients were jaundiced [92.8%] with elevated serum alkaline phosphatase in all of them. Ultrasonography had a 100% success rate to detect; IHBD, localized collection and free intra-peritoneal bile. The success rate to localize the site of the injury was 64.3%, it also evaluated accurately the liver parenchymal pathology. MRCP was the key stone in the diagnosis of the site and the extent of the bile duct injury with a 100% success rate in visualization of the biliary tree below and above the stricture. ERCP failed to opacify the bile ducts proximal to the stricture in 48% of the patients. In this group, low stricture [Bismuth type I and II] was the common finding [84%]. Bilio-enteric anastomosis without preoperative stenting of the bile ducts was done safely for all patients [except one where the procedure could not be completed] with excellent and good results in 82% of our patients