Iatrogenic bile duct injuries after laparoscopic cholecystectomy: evaluation by MRCP before management

Abstract

Background Iatrogenic bile duct injuries are unusual but possibly associated with fatal complications with increased incidence since the introduction of laparoscopic cholecystectomy. Appropriate estimation of these injuries is essential for proper management. Imaging is vital for the initial diagnosis, extent assessment and consequently, treatment guidance of bile duct injury with an ideal outcome. In this study, MRCP was carried out in 37 cases (28 females and 9 males, age range from 19 to 58 years) with suspected BDI following laparoscopic cholecystectomy. MRCP images were assessed for bile duct transection injury, strictures, biliary leakage, and intrahepatic biliary radicles (IHBR) dilatation. In positive cases, Strasberg classification system was used with the definitive diagnosis was done regarding the surgical findings and/or findings on endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC). Results Our study includes 37 cases with biliary injuries. On MRCP our cases were stratified regarding the Strasberg-Bismuth classification into five types (A to E). Most BDIs were type E2 (29.7%), followed by type E1 (18.9%), type A (16.2%), type E3 (10.8%), type E4 (8.2%), type C (5.4%), and type D and finally type E5 and B injuries with each one representing 2.7%. Twenty cases presented with biliary leakage and seventeen with bile duct obstruction, whether duct ligation or stricture. Conclusion MRCP is an essential imaging modality for assessment of iatrogenic BDIs enabling the radiologists to classify these injuries and helps to govern the management.

The management of a duodenal fistula involving the right hepatic duct: a rare case report

“…The non-traumatic and non-ionizing nature of MRCP, along with its exceptional ability to provide clear visualization of the biliary system, suggests that it is advisable to perform preoperative MRCP. This facilitates the assessment of abnormal anatomical bile ducts and mitigates the risk associated with iatrogenic bile duct injury ( 13 , 14 ). Inflammation and intraoperative bleeding also significantly impact the surgeon’s ability to judge surrounding anatomy, increasing the likelihood of bile duct damage when using electrocautery devices ( 15 ).…”