Iatrogenic bile duct strictures: a review of 22 cases

The incidence of iatrogenic bile duct strictures in Ethiopia appears to be increasing. Of 27 patients that sustained bile duct injuries at open cholecystectomy, admitted during May 1996 to December 2002, 22 cases of bile duct strictures are presented to evaluate outcome of treatment. The mean age was 40 years, 15 females. Twenty-one were referrals. The usual presenting features were biliary peritonitis and jaundice. The average time lapse between the original surgery and admission to hospital was eight months. About 73% had Bismuth grade III-IV strictures and all patients underwent Roux-en-Y hepatico-jejunostomy. Postoperatively, biliary-cutaneous fistula, recurrent ascending cholangitis and wound infection were observed frequently. The overall mortality rate was 13.6%. Bile duct injuries and strictures occur in young productive age groups. Prevention of the occurrence of bile duct injury and its progression to a devastating stricture reduces morbidity and mortality.