Experience with post cholecystectomy obstructive jaundice

ABSTRACT

13 cases of post cholecystectomy obstructive jaundice were the material of this work. They were operated upon in Assiut University Hospital in the period from January 1991 to May 1992. 11 cases were referred from other hospitals and 2 were from Assiut University Hospital. 10 cases were females and 3 were males. Their ages ranged from 25 to 70 years. The lapse of time between cholecystectomy and the development of jaundice ranged from 3 days to 6 months. All of the 13 cases were subjected to full clinical and laboratory investigations to exclude hepatitis and hepatocellular failure and to assess, the liver function. Ultrasonography for all cases and C.T. scan were done for 3 cases. ERCP was not done because it is not available in A.U.H. The cause of post-operative obstruction was found to be missed stone in the common bile duct in 4 cases, ligation of the common duct with silk suture in 4 cases, injury of the common duct in one case which presented with collection of bile in the peritoneal cavity, a missed-stone in the cystic duct stump which was parallel to the common hepatic duct in one case. A reformed stone in the common bile duct in one case. A missed towel in the porta hepatis was found in one case, In the last case the cause of obstruction was cancer head of pancreas which was not detected at the time of the operation for cholecystectomy and the patient came back with jaundice 3 months after cholecystectomy. Correction of post cholecystectomy obstructive jaundice was in the form of re-exploration of the biliary passages and dealing with the cause. Removal of stone or ligature, repair of the injured duct over T shaped tube, and choledechonastomy in the case of cancer head of pancreas. From this we can say that the majority of post operative obstructive jaundice can be avoided by careful pre-operative evaluation, proper operative technique, good idea about the anatomy of the biliary tract with its anomalies, and above all the use of intraoperative cholangiography