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Injury to an accessory bile duct during laparoscopic cholecystectomy
H P Klotz1, R Schlumpf, F Largiadèr
1Department of Surgery, Zurich University Hospital, Switzerland.
Surgical Laparoscopy & Endoscopy
|December 1, 1992
Summary
An accessory bile duct injury after laparoscopic cholecystectomy can cause bile leaks. Operative cholangiography and prompt endoscopic retrograde cholangiopancreatography (ERCP) are key for diagnosis and management.
Area of Science:
- Gastroenterology
- Surgical Anatomy
- Biliary Surgery
Background:
- Anatomic variations in the bile duct system are common, with accessory ducts often going unrecognized.
- Laparoscopic cholecystectomy is a frequent procedure, but carries risks of bile duct injury.
Observation:
- A 53-year-old woman developed symptomatic bile collection post-laparoscopic cholecystectomy for cholecystolithiasis.
- Endoscopic retrograde cholangiopancreatography (ERCP) revealed a bile leak from an accessory bile duct in the gallbladder bed.
Findings:
- Relaparoscopy successfully identified and clipped the injured accessory bile duct.
- This case highlights symptomatic injury to an accessory bile duct as a rare but challenging complication.
Implications:
- Intraoperative operative cholangiography is recommended to identify biliary anomalies.
- Prompt ERCP with simultaneous sphincterotomy is crucial for managing postoperative bile leaks.
- Laparoscopic repair is a viable option for accessory bile duct injuries when necessary.