Common Bile Duct Stricture After Laparoscopic Cholecystectomy: Case Report

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.

Acquired Blaschko Dermatitis-seventh case.

The February edition of Dermatology Online Journal 2002;7(1):8, contained an article entitled Acquired Blaschko Dermatitis.[1] A 64 year old patient with erythematous patches and papules in a reticulate pattern on the left upper extremity and on the left side of the chest, abdomen, back and buttock was described. Three months later, in the Department of Dermatology, Health Center Krusevac, we examined a 65 year old woman with similar lesions, distributed in a linear pattern on her right lower limb, following the lines of Blaschko.