Value of MRI in three patients with major vascular injuries after laparoscopic cholecystectomy
Alfonso Ragozzino1, Francesco Lassandro, Rosaria De Ritis
1Department of Radiology, Cardarelli Hospital and University Federico II, Via Pansini 5, Napoli, Italy.
Abstract:
The aim of this study was to describe three cases of major vascular injuries after laparoscopic cholecystectomy depicted on magnetic resonance (MR) examination. Three female patients (mean age, 32 years; range, 22-39 years) were studied with clinical suspicion of bilio-vascular injuries after laparoscopic cholecystectomy. All MR examinations were performed within 24 h after the laparoscopic procedure. MR imaging was evaluated for major vascular injuries involving the arterial and portal venous system, for bile duct discontinuity, presence or absence of biliary dilation, stricture, excision injury, free fluid and collections. In the first patient, a type-IV Bismuth injury with associated intrahepatic bile ducts dilation was observed. Contrast-enhanced MR revealed lack of enhancement in the right hepatic lobe due to occlusion of the right hepatic artery and the right portal branch. This patient underwent right hepatectomy with hepatico-jejunostomy. In the other two cases, no visualization of the right hepatic artery and the right portal branch was observed on MR angiography. In the first case, the patient underwent right hepatectomy; in the second case, because of stable liver condition, the patient was managed conservatively. MR imaging combined with MR angiography and MR cholangiography can be performed emergently in patients with suspicion of bilio-vascular injury after laparoscopic cholecystectomy allowing the simultaneous evaluation of the biliary tree and the hepatic vascular supply that is essential for adequate treatment planning.
Insights
Magnetic resonance imaging (MRI) effectively diagnoses major vascular injuries following laparoscopic cholecystectomy. This imaging modality aids in prompt treatment planning for complex bilio-vascular complications.
Area of Science:
- Radiology
- Gastroenterology
- Surgical Complications
Background:
- Laparoscopic cholecystectomy, a common procedure, can rarely lead to severe bilio-vascular injuries.
- Prompt diagnosis and management are critical for patient outcomes.
Observation:
- Three female patients presented with suspected vascular injuries post-laparoscopic cholecystectomy.
- Magnetic resonance (MR) examinations were performed within 24 hours of surgery.
- MR imaging assessed vascular injury, bile duct integrity, and fluid collections.
Findings:
- One patient had a type-IV Bismuth injury with right hepatic artery and portal vein occlusion, treated with right hepatectomy.
- Two patients showed non-visualization of the right hepatic artery and portal branch on MR angiography.
- Conservative management was successful in one patient with stable liver condition.
Implications:
- MR imaging, including MR angiography and MR cholangiography, is crucial for emergent evaluation of suspected bilio-vascular injuries.
- Simultaneous assessment of the biliary tree and hepatic vascular supply guides treatment planning.
- This approach is essential for managing complex post-cholecystectomy complications.