Iatrogenic bile duct injury during open nephrectomy

Abstract

Introduction: Iatrogenic bile duct injury can occur during several intra-abdominal surgeries, such as hepatobiliary, pancreatic duodenal and gastric surgeries. Here we report a first case of bile duct injury, occurred during attempt of open nephrectomy. Case report: A 35 year old male presented with antecedent history iatrogenic duodenal injury at the level of papilla during nephrectomy for non functioning kidney. Which was managed by resection of the 2-3 cm of bowel and hand sewn end to end anastomosis. Nephrectomy could not perform due to dense perinephric adhesions. In postoperative period, patient developed sepsis, Raised TLC (12,800 /ml) counts and high bilious drain output. Upper gastrointestinal contrast study was showing extravagation of dye from duodenum in subhepatic space with air. Patient was managed conservatively by Broad spectrum antibiotics, placing CT guided multiple percutaneous drains, drain manipulation and nutritionally supported by NJ feeding. By this mean fistula was controlled. Latter patient developed stricture of the common channel of bilipancreatic ducts which revealed on MRCP and PTBD gram and patient managed by Side-to-Side, 2.5 cm, longitudinal, Roux- en-Y Choledochojejunostomy. Results: In immediate postoperative period he remained hemodynamically stable, on 4th postoperative day he developed large collection in the lesser sac which managed with intravenous antibiotics and percutaneous drains. We found no abnormality in last 1 year follow-up Conclusion: Iatrogenic bile duct injury, which occurs during intraabdominal surgeries, usually recognized in later stage, initially these patient required multidisciplinary approach and latter managed by hepatobiliary reconstruction.