RESUMEN
Spontaneous or idiopathic bile duct perforation is rare, mostly seen in children from 25 weeks of gestation to 7 years of age, with the confluence of cystic duct and common hepatic duct (CHD) being the most common site. The exact aetiopathogenesis remains elusive and poorly understood, leading to a lack of consensus on its optimal management. The condition is often diagnosed intraoperatively. We present a case of spontaneous perforation of the CHD in a boy in his middle childhood, alongside a review of relevant literature. The patient presented with acute abdomen and pyobiliary peritonitis, for which a hollow viscus perforation was suspected. An emergent laparotomy revealed a 0.5 cm CHD perforation. Surgical intervention involved T-tube insertion and drainage, leading to a successful recovery. This case underscores the challenge of preoperative diagnosis, necessitating prompt exploration after initial resuscitation. There is a need for clinical vigilance and tailored surgical approaches.
Asunto(s)
Conducto Hepático Común , Perforación Espontánea , Humanos , Masculino , Perforación Espontánea/cirugía , Conducto Hepático Común/cirugía , Conducto Hepático Común/lesiones , Niño , Abdomen Agudo/etiología , Abdomen Agudo/cirugía , Laparotomía/métodos , DrenajeRESUMEN
We report the case of a woman in her 40s, with no significant medical history, submitted to a laparoscopic cholecystectomy in our institution for symptomatic gallbladder lithiasis. On postoperative day 4, she presented to our emergency room with severe abdominal pain and elevated inflammatory markers. Abdominal CT scan revealed a mass filled with liquid and air in the gallbladder fossa. Surgical exploration was performed revealing a major common hepatic duct iatrogenic injury, which was managed using suture over a T-tube. Three months after surgery, cholangiography showed a biliary stenosis, and a biodegradable stent was inserted through percutaneous transhepatic access. The difficulties in the management of this condition and its outcomes are discussed in this report.
Asunto(s)
Colecistectomía Laparoscópica , Femenino , Humanos , Colangiografía , Colecistectomía Laparoscópica/efectos adversos , Vesícula Biliar , Conducto Hepático Común/cirugía , Conducto Hepático Común/lesiones , Enfermedad Iatrogénica , AdultoAsunto(s)
Enfermedades de los Conductos Biliares/terapia , Cateterismo , Hepatectomía/efectos adversos , Conducto Hepático Común/lesiones , Enfermedades de los Conductos Biliares/diagnóstico por imagen , Enfermedades de los Conductos Biliares/etiología , Femenino , Conducto Hepático Común/diagnóstico por imagen , Humanos , Persona de Mediana Edad , Punciones , Resultado del TratamientoAsunto(s)
Técnicas de Ablación , Conducto Colédoco/lesiones , Disección/métodos , Conducto Hepático Común/lesiones , Neoplasias Hepáticas/cirugía , Microondas/uso terapéutico , Solución Salina/uso terapéutico , Heridas y Lesiones/prevención & control , Técnicas de Ablación/efectos adversos , Anciano , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/secundario , Microondas/efectos adversos , Persona de Mediana Edad , Resultado del Tratamiento , Heridas y Lesiones/etiologíaRESUMEN
Treatment of bile ducts injuries (BDI) treatment, combining minimally access surgical techniques, although their benefits, has been scarcely reported. We described a combined laparoscopic-endoscopic procedure, carried out in a patient with postoperative right hepatic duct (RHD) injury associated to laparoscopic cholecystectomy. Based on a clinical case description, we illustrate the surgical technique and assess their applicability and results. A biliary fistula was identified employing laparoscopic cholangiography and a metallic clip applied, producing RHD occlusion, was retrieved under fluoroscopic guidance. A biliary "rendezvous" maneuver was done for positioning an endoscopic biliary stent. The biliary fistula disappeared within two weeks and during 40-months of follow-up the patient remains asymptomatic. Laparoscopic-endoscopic approach, although technically demanding, resulted effective to treat this patient. A Continuous follow-up is essential for evaluating the long-term results.
Asunto(s)
Fístula Biliar/cirugía , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colecistectomía Laparoscópica/efectos adversos , Conducto Hepático Común/lesiones , Laparoscopía/métodos , Complicaciones Posoperatorias/cirugía , Adulto , Fístula Biliar/diagnóstico por imagen , Fístula Biliar/etiología , Femenino , Conducto Hepático Común/diagnóstico por imagen , Conducto Hepático Común/cirugía , Humanos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/diagnóstico por imagenRESUMEN
RESUMEN El tratamiento de las lesiones quirúrgicas de las vías biliares (LQVB), empleando procedimientos quirúrgicos de mínimo acceso en forma conjunta, a pesar de sus beneficios, ha sido escasamente reportado. Describimos el tratamiento combinado láparoendoscópico, en una paciente con fístula biliar y estenosis postoperatoria del conducto hepático derecho (CHD). Con base en la descripción de un caso clínico, ilustramos la técnica quirúrgica y evaluamos su aplicabilidad y resultados. Empleando colangiografía laparoscópica, identificamos la fistula biliar y demostramos la oclusión del CHD por un clip metálico, el cual fue retirado mediante guía fluoroscópica. Realizamos maniobra de "rendezvous" biliar y colocamos de prótesis plástica endoscópica. La fístula biliar resolvió en 12 días y a 40 meses de seguimiento, la paciente permanece sin alteraciones. El abordaje láparo-endoscópico, aunque técnicamente demandante, resultó efectivo para el tratamiento de esta paciente. Su seguimiento es fundamental y de especial interés, a fin de evaluar los resultados a largo plazo.
ABSTRACT Treatment of bile ducts injuries (BDI) treatment, combining minimally access surgical techniques, although their benefits, has been scarcely reported. We described a combined laparoscopic-endoscopic procedure, carried out in a patient with postoperative right hepatic duct (RHD) injury associated to laparoscopic cholecystectomy. Based on a clinical case description, we illustrate the surgical technique and assess their applicability and results. A biliary fistula was identified employing laparoscopic cholangiography and a metallic clip applied, producing RHD occlusion, was retrieved under fluoroscopic guidance. A biliary "rendezvous" maneuver was done for positioning an endoscopic biliary stent. The biliary fistula disappeared within two weeks and during 40-months of follow-up the patient remains asymptomatic. Laparoscopic-endoscopic approach, although technically demanding, resulted effective to treat this patient. A Continuous follow-up is essential for evaluating the long-term results.
Asunto(s)
Adulto , Femenino , Humanos , Complicaciones Posoperatorias/cirugía , Fístula Biliar/cirugía , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colecistectomía Laparoscópica/efectos adversos , Laparoscopía/métodos , Conducto Hepático Común/lesiones , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/diagnóstico por imagen , Fístula Biliar/etiología , Fístula Biliar/diagnóstico por imagen , Conducto Hepático Común/cirugía , Conducto Hepático Común/diagnóstico por imagenRESUMEN
BACKGROUND AND AIMS: Right aberrant hepatic ducts are an anatomic variant with clinical relevance because of the risk of injury during cholecystectomy. Treatment options for aberrant hepatic duct injuries are not standardized. This study aims to analyze the long-term results of endoscopic treatment of aberrant hepatic duct lesions. METHODS: Patients who underwent ERCP for aberrant hepatic duct lesions were retrospectively identified. Demographic data, type of aberrant duct lesion according to the Strasberg classification, type of treatment (number of plastic stents inserted, treatment duration, and number of ERCPs), and adverse events were recorded. Follow-up was obtained by telephone contact or medical examinations. RESULTS: Between January 1996 and March 2019, 32 patients (78% women, mean age 51.7 years) with aberrant hepatic duct injuries underwent ERCP at our Endoscopy Unit. Six patients had Strasberg type B lesions, 11 patients had type C, and 8 patients had type E5, and 7 patients had a stenosis of the aberrant duct. A mean of 3.7 biliary plastic stents per patient were used; mean treatment duration was 6.3 months. All patients with isolated aberrant duct stenosis and 1 of 6 patients (17%) with type B Strasberg lesions achieved patency. Ten of 11 patients (91%) with type C Strasberg lesions achieved duct recanalization. After a mean follow-up of 109.3 ± 61.2 months, 29 of 32 patients (91%) were asymptomatic; 1 underwent surgery for recurrent cholangitis, 1 received a new endoscopic procedure because of cholangitis, and 1 reported episodic biliary colic without an increase in liver function test values and was successfully managed with a low-fat diet. CONCLUSIONS: An endoscopic approach to aberrant hepatic duct lesions after cholecystectomy can be considered an effective first-line therapy.
Asunto(s)
Conductos Biliares Extrahepáticos , Colangiopancreatografia Retrógrada Endoscópica , Colecistectomía Laparoscópica , Adulto , Anciano , Conductos Biliares Extrahepáticos/anomalías , Conductos Biliares Extrahepáticos/diagnóstico por imagen , Conductos Biliares Extrahepáticos/lesiones , Conductos Biliares Extrahepáticos/cirugía , Colangiopancreatografia Retrógrada Endoscópica/métodos , Pancreatocolangiografía por Resonancia Magnética , Colecistectomía/efectos adversos , Colecistectomía Laparoscópica/efectos adversos , Endoscopía del Sistema Digestivo , Femenino , Estudios de Seguimiento , Conducto Hepático Común/anomalías , Conducto Hepático Común/diagnóstico por imagen , Conducto Hepático Común/lesiones , Conducto Hepático Común/cirugía , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Stents , Resultado del TratamientoRESUMEN
A 42-year-old woman sustained complete transection of common hepatic duct during routine laparoscopic cholecystectomy. The surgery was being performed at a rural setting, and the injury was identified intraoperatively. The surgeon sought the opinion of an expert biliary surgeon via telephone and discussed the possibility of an immediate end-to-end bile duct repair. Since he lacked the experience of doing biliary-enteric anastomosis, he was advised to place a subhepatic drain and transfer the patient to the hepatobiliary centre for definitive surgery. At the referral centre, the patient was evaluated and planned an immediate biliary repair. On exploration, she was found to have a major type, Strasberg E5 injury. The transected ducts were small in calibre and required double Roux-en-Y hepaticojejunostomy over transanastomotic stents. The postoperative recovery was uneventful. Transanastomotic stents were removed after 6 months, and the patient remained perfectly well at a follow-up of 1 year.
Asunto(s)
Colecistectomía Laparoscópica/efectos adversos , Conducto Hepático Común/lesiones , Derivación y Consulta , Adulto , Anastomosis Quirúrgica , Diagnóstico Diferencial , Femenino , Humanos , Complicaciones Intraoperatorias/diagnóstico , Complicaciones Intraoperatorias/cirugíaAsunto(s)
Carcinoma Hepatocelular/cirugía , Absceso Hepático/etiología , Microondas/efectos adversos , Administración Intravenosa , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Síndrome de Budd-Chiari/patología , Quimioembolización Terapéutica/métodos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Conducto Hepático Común/lesiones , Conducto Hepático Común/efectos de la radiación , Humanos , Absceso Hepático/tratamiento farmacológico , Absceso Hepático/cirugía , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/cirugía , Masculino , Microondas/uso terapéutico , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Vena Porta/patología , Vena Porta/cirugía , Stents , Resultado del TratamientoRESUMEN
Iatrogenic bile duct injuries during cholecystectomy can present as fulminant intra-abdominal sepsis which precludes immediate repair or biliary reconstruction. We report the case of a 29-year-old female patient who sustained a bile duct injury after an open cholecystectomy in a neighboring country. She presented to our institution 22 d after initial surgery with septic shock and multiple intra-abdominal collections. Endoscopic retrograde cholangiography revealed a large common hepatic duct defect corresponding to a Strasberg type D bile duct injury. Definitive reconstruction such as a hepaticojejunostomy cannot be performed due to the presence of dense adhesions with infected and friable tissues. She underwent a combination of endoscopic biliary stenting and pedicled omental patch repair of the bile duct to control bile leak and sepsis as a bridging procedure to definite hepaticojejunostomy three months later.
Asunto(s)
Enfermedades de los Conductos Biliares/cirugía , Colecistectomía/efectos adversos , Colecistitis Aguda/cirugía , Conducto Hepático Común/lesiones , Epiplón/cirugía , Procedimientos de Cirugía Plástica/métodos , Choque Séptico/cirugía , Adulto , Enfermedades de los Conductos Biliares/diagnóstico por imagen , Enfermedades de los Conductos Biliares/etiología , Colangiopancreatografia Retrógrada Endoscópica , Femenino , Conducto Hepático Común/diagnóstico por imagen , Conducto Hepático Común/cirugía , Humanos , Enfermedad Iatrogénica , Procedimientos de Cirugía Plástica/instrumentación , Choque Séptico/diagnóstico por imagen , Choque Séptico/etiología , Stents , Colgajos Quirúrgicos , Tomografía Computarizada por Rayos XRESUMEN
Despite progress in laparoscopic surgery and increasing surgical experience, the incidence of bile duct injury during laparoscopic cholecystectomy fails to fall below 0.3%-0.6% and it is still higher than those recorded in the era of open cholecystectomy. Bile duct injuries belong to the most serious complications of abdominal surgery in general and often end up with liver transplantation as the only hope for cure. We present a case of a 78-year-old jaundiced male patient who sustained common hepatic duct injury during laparoscopic cholecystectomy eight months earlier. Exploratory laparotomy, ERCP and MRCP revealed a metal clip placed just below hepatic duct confluence and causing stricture of bile duct with dilatation of bile ducts proximal to the level of stenosis (Strasberg classification type E3 injury). Repair of the injury was performed by creating termino-lateral hepaticojejunostomy between the right and left hepatic ducts and retrocolic Roux en-Y jejunal limb. By presenting this case, we wish to emphasize the importance of timely conversion and execution of intraoperative cholangiography in all cases when identification of the structures of Calot's triangle is not clear enough. Successful treatment of bile duct injury is only possible with joint approach of radiologist, gastroenterologist and experienced hepatobiliary surgeon.
Asunto(s)
Colecistectomía Laparoscópica , Enfermedades del Conducto Colédoco/diagnóstico por imagen , Constricción Patológica/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Anciano , Colangiopancreatografia Retrógrada Endoscópica , Pancreatocolangiografía por Resonancia Magnética , Conducto Colédoco , Enfermedades del Conducto Colédoco/cirugía , Constricción Patológica/cirugía , Conducto Hepático Común/diagnóstico por imagen , Conducto Hepático Común/lesiones , Conducto Hepático Común/cirugía , Humanos , Yeyunostomía , Laparotomía , Masculino , Complicaciones Posoperatorias/cirugíaAsunto(s)
Colangiopancreatografia Retrógrada Endoscópica/métodos , Vesícula Biliar/cirugía , Conducto Hepático Común/cirugía , Imanes , Heridas no Penetrantes/cirugía , Adolescente , Anastomosis Quirúrgica/métodos , Pancreatocolangiografía por Resonancia Magnética , Colecistectomía , Vesícula Biliar/lesiones , Conducto Hepático Común/lesiones , Humanos , MasculinoAsunto(s)
Colecistectomía Laparoscópica/legislación & jurisprudencia , Conducto Colédoco/lesiones , Conducto Colédoco/cirugía , Testimonio de Experto/legislación & jurisprudencia , Mala Praxis/legislación & jurisprudencia , Errores Médicos/legislación & jurisprudencia , Colecistitis Aguda/cirugía , Cálculos Biliares/cirugía , Alemania , Hepatectomía/legislación & jurisprudencia , Conducto Hepático Común/lesiones , Conducto Hepático Común/cirugía , Humanos , Yeyunostomía/legislación & jurisprudencia , ReoperaciónAsunto(s)
Colangiopancreatografia Retrógrada Endoscópica/métodos , Colecistectomía/efectos adversos , Conducto Hepático Común , Complicaciones Intraoperatorias , Colecistectomía/métodos , Femenino , Conducto Hepático Común/lesiones , Conducto Hepático Común/cirugía , Humanos , Complicaciones Intraoperatorias/diagnóstico , Complicaciones Intraoperatorias/etiología , Complicaciones Intraoperatorias/fisiopatología , Complicaciones Intraoperatorias/cirugía , Persona de Mediana Edad , Reoperación/métodos , Cirugía Asistida por Computador/métodos , Resultado del Tratamiento , Ultrasonografía/métodosRESUMEN
Bile duct injuries (BDIs) are difficult to avoid absolutely when the biliary tract has a malformation, such as accessory hepatic duct. Here, we investigated the management strategies for BDI combined with accessory hepatic duct during laparoscopic cholecystectomy.
Asunto(s)
Colecistectomía Laparoscópica/efectos adversos , Conducto Colédoco/cirugía , Conducto Hepático Común/cirugía , Yeyunostomía , Técnicas de Sutura , Conducto Colédoco/lesiones , Conducto Hepático Común/anomalías , Conducto Hepático Común/lesiones , Humanos , Ligadura , Reoperación , Stents , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Fuga Anastomótica/cirugía , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colecistectomía Laparoscópica/efectos adversos , Enfermedades del Conducto Colédoco/cirugía , Conducto Colédoco/lesiones , Conducto Hepático Común/lesiones , Cirugía Asistida por Computador/métodos , Adulto , Fuga Anastomótica/diagnóstico , Conducto Colédoco/cirugía , Enfermedades del Conducto Colédoco/diagnóstico , Enfermedades del Conducto Colédoco/etiología , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Conducto Hepático Común/cirugía , Humanos , Masculino , Persona de Mediana Edad , Reoperación , Estudios RetrospectivosAsunto(s)
Colangiografía , Conducto Colédoco/lesiones , Endoscopía del Sistema Digestivo/métodos , Extravasación de Materiales Terapéuticos y Diagnósticos/terapia , Conducto Hepático Común/lesiones , Enfermedad Iatrogénica , Adulto , Anciano , Anciano de 80 o más Años , Colangiografía/efectos adversos , Colecistectomía Laparoscópica/efectos adversos , Endoscopía del Sistema Digestivo/efectos adversos , Extravasación de Materiales Terapéuticos y Diagnósticos/diagnóstico por imagen , Femenino , Hepatectomía/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
PURPOSE: To assess biliary complications after irreversible electroporation (IRE) ablation of hepatic tumors located < 1 cm from major bile ducts. MATERIALS AND METHODS: A retrospective review was conducted of all percutaneous IRE ablations of hepatic tumors within 1 cm of the common, left, or right hepatic ducts at a single institution from January 2011 to September 2012. Computed tomography imaging performed before and after treatment was examined for evidence of bile duct dilatation, stricture, or leakage. Serum bilirubin and alkaline phosphatase levels were analyzed for evidence of biliary injury. RESULTS: There were 22 hepatic metastases in 11 patients with at least one tumor within 1 cm of the common, left, or right hepatic duct that were treated with IRE ablations in 15 sessions. Median tumor size treated was 3.0 cm (mean, 2.8 cm ± 1.2, range, 1.0-4.7 cm). Laboratory values obtained after IRE were considered abnormal after four treatment sessions in three patients (bilirubin, 2.6-17.6 mg/dL; alkaline phosphatase, 130-1,035 U/L); these abnormal values were transient in two sessions. Two patients had prolonged elevation of values, and one required stent placement; both of these conditions appeared to be secondary to tumor progression rather than bile duct injury. CONCLUSIONS: This clinical experience suggests that IRE may be a treatment option for centrally located liver tumors with margins adjacent to major bile ducts where thermal ablation techniques are contraindicated. Further studies with extended follow-up periods are necessary to establish the safety profile of IRE in this setting.
Asunto(s)
Técnicas de Ablación , Electroporación , Conducto Hepático Común/patología , Neoplasias Hepáticas/cirugía , Técnicas de Ablación/efectos adversos , Anciano , Anciano de 80 o más Años , Fosfatasa Alcalina/sangre , Bilirrubina/sangre , Biomarcadores/sangre , Colestasis/sangre , Colestasis/diagnóstico por imagen , Colestasis/etiología , Progresión de la Enfermedad , Femenino , Conducto Hepático Común/diagnóstico por imagen , Conducto Hepático Común/lesiones , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/secundario , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Carga TumoralRESUMEN
An aberrant right posterior hepatic duct is present in 4.8-8.4% of the population. It is one of the causes of bile duct injury during laparascopic cholecystectomy. Herein we present a patient with complete transection of the common hepatic duct during laparascopic cholecystectomy (Stewart-Way class 3). Interestingly, the patient had an intact aberrant right posterior duct draining into the common hepatic duct distal to the obstruction site that prevented early diagnosis of the biliary injury because of drainage of the liver sufficient to prevent the development of jaundice.
Asunto(s)
Variación Anatómica , Colecistectomía Laparoscópica , Colestasis/etiología , Conducto Hepático Común/anatomía & histología , Conducto Hepático Común/lesiones , Complicaciones Intraoperatorias/etiología , Femenino , Humanos , Ictericia , Persona de Mediana EdadRESUMEN
Isolated hepatic duct confluence injury due to trauma is unusual. Two cases of isolated bile duct injury are presented, which were diagnosed and managed successfully at our institution.