Surgical Management of Sectoral Bile Duct Injury after Cholecystectomy - A Case Series

Abstract

Introduction: Injuries to segmental or sectoral bile ducts are encountered less commonly than main bile duct injuries and present a unique diagnostic and therapeutic challenge. Methods: This retrospective study was conducted and data of patients who underwent surgery for sectoral bile duct injury were retrieved from January 2014 to December 2019. Results: Four patients were analyzed. All four were females with mean age of 36.5 years. Two of the four patients had undergone an open cholecystectomy, whereas the remaining two patients had undergone a laparoscopic cholecystectomy. The clinical presentation was external biliary fistula in two and another two patients presented with Pain and fever. Two patients without biliary fistula had late presentation at 2 year and 6 year respectively after index surgery. Two patients had undergone endoscopic retrograde cholangiography (ERCP), the result of ERCP had been interpreted as normal with no leak in one patient, and cystic stump leak in one patient. All patient had undergone magnetic resonance cholangiopancreatography (MRCP). Two of the four patient had right posterior sectoral duct injury and one patient had right anterior sectoral duct injury, one patient had stricture involving right hepatic duct leading to disconnection from common hepatic duct. All patients underwent Roux- en -Y cholangiojejunostomy. At mean follow up of 27 months (range 4 to 68 months) all patients are asymptomatic. Conclusion: Segmental/sectoral bile duct injury should always be suspected and looked for if a biliary leak following cholecystectomy persists. Surgical treatment for this type of lesions, generally results in a favorable outcome.