Iatrogenic bile duct injuries

ABSTRACT

Twenty-two patients with postcholecystectomy bile duct injuries were managed in the Surgical Unit in period from June 1989 to June 1992. They were 18 females and 4 males. Their ages ranged between 25-60 years with a mean of 43 years. The timing and mode of presenting manifestation varied. In only two patients injuries were recognized intraoperatively. Thirteen patients [59.1%] presented within one month POP. Recurrent cholangitis was the most frequent presenting manifestation [54.5%]. Preoperative diagnostic work up included US, PTC, ERCP and CT, and when added to operative findings, stricture level and type of injury could be demonstrated. Bismuth types 2 and 3 strictures were found in 16/22 [77.7%], while ligated bile duct was the most frequent type of injury 14/22 [63.6%]. End to side Roux en Y hepaticojejunostomy was performed in 14.22 [63.3%], while end-to-end anastomosis on a T-tube stent wasdone for 2 patients with intraoperative recognition of injury [9.1%]. Choledochoduodenostomy was performed in 2 patients [9%], Roux en Y choledochojejunostomy in 2 patients [9.1%] while, portojejunostomy was done for another 2 patients [9.1%]. The period of postoperative follow up ranged between 12-36 months with a mean of 20.5 months. Only one mortality [4.65%] was met with, while early specific morbidity were encountered in 6 patients. Five patients showed late specific morbidity [one restenosis and 4 mild recurrent cholangitis]