Iatrogenic Bile Duct Injury What And When?

Abstract

A prospective study of patients with iatrogenic bile duct injury (IBDI) on what to do and when to do; over a period of
one year at a tertiary health care center.
AIMS AND OBJECTIVES :
1. A compilation of various presenting scenarios of patient with IBDI.
2. Modalities of investigation.
3. When and how to intervene.
MATERIALS AND METHODS :
Over a period of one year, 20 patients with iatrogenic bile duct injury were divided into two categories – one, those
who were diagnosed intraoperative and second, who were diagnosed after 24 to 48 hours. Patients in second
category were further subdivided into those who underwent immediate intervention and those who were kept
conservative for 8-12 weeks and operated on after that.
These patients were assessed on various clinical, biochemical and radiological parameters like vitals, per
abdomen examination, hemogram, liver function tests, ultrasound, MRCP, ERCP and CECT.
RESULTS :
Out of 20 patients, only 2 patients were diagnosed to have IBDI intraoperative, t-tube placement done in one and in
another the proximal end was tied.
Out of the other 18 – 2 presented with biliary peritonitis and had to be re-explored.
The other 16 were stable and could be kept conservative till 3 months following which a delayed attempt at bilioenteric
reconstruction was given with a uneventful post operative course.
CONCLUSION
Intraoperative diagnosis is difficult in cases of IBDI but after 24-48 hours – prompt intervention in patients with
developing biliary peritonitis and delayed intervention in stable patients with close follow up of their clinical course
is crucial in preventing IBDI related mortality and morbidity.