Associated vascular injury in patients with bile duct injury during cholecystectomy
Alex M Keleman1, David K Imagawa, Laura Findeiss
1University of California, Irvine Medical Center, Orange, California, USA. akeleman@uci.edu
Insights
Cholecystectomy can cause bile duct (BD) and vascular injuries. Imaging like CT angiograms are crucial for preoperative evaluation in patients with BD injuries to identify potential vascular damage.
Area of Science:
- General Surgery
- Vascular Surgery
- Hepatobiliary Surgery
Background:
- Cholecystectomy is a frequent surgical procedure.
- Bile duct (BD) injuries are well-documented, but associated vascular injuries are less understood.
Purpose of the Study:
- To determine the frequency and management of vascular and BD injuries after cholecystectomy.
- To highlight the importance of identifying vascular complications.
Main Methods:
- Retrospective analysis of 50 patients with BD injuries from 1996-2010.
- Review of patient demographics, injury types (Strasberg classification), and management strategies.
Main Results:
- 18% of patients with BD injuries had associated vascular injuries.
- Right hepatic artery (6 patients) and right portal vein (5 patients) were most commonly injured.
- Mortality occurred in 3 patients with portal vein injuries.
Conclusions:
- Associated vascular injuries are common after cholecystectomy.
- Preoperative thin-collimation CT angiogram and/or mesenteric angiogram with portal venous imaging are recommended for patients with BD injuries.
Abstract:
Cholecystectomy remains one of the most commonly performed procedures in general surgery. Although the incidence, diagnosis, and treatment of bile duct (BD) injuries have been well described, studies characterizing associated vascular injuries are limited. The objective of this study was to analyze the frequency and management of associated vascular and BD injury after cholecystectomy. A total of 50 patients were referred to a tertiary institution for BD injuries from 1996 to 2010. Thirty-nine (78%) of the patients were female with the mean age of 49 years (range, 14 to 86 years). Seventy-five per cent of the injuries were Strasberg Type E. Nine patients (18%) had associated vascular injuries. Six patients had injuries to the right hepatic artery; in one patient, both the right and left hepatic arteries were damaged. Five patients had right portal vein injuries; three of these subsequently died. In conclusion, as a result of the high incidence of associated vascular injury, a thin-collimation CT angiogram and/or mesenteric angiogram with portal venous imaging should be considered as part of the preoperative evaluation in patients with BD injury.
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