Case Report
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. May 14, 2009; 15(18): 2283-2286
Published online May 14, 2009. doi: 10.3748/wjg.15.2283
Repair of a mal-repaired biliary injury: A case report
Awad Aldumour, Paolo Aseni, Mohmmad Alkofahi, Luca Lamperti, Elias Aldumour, Paolo Girotti, Luciano Gregorio De Carlis
Awad Aldumour, Paolo Aseni, Mohmmad Alkofahi, Luca Lamperti, Elias Aldumour, Paolo Girotti, Luciano Gregorio De Carlis, Department of Hepatobiliary Surgery and Liver Transplantation Unit, Niguarda Hospital, 20162 Milan, Italy
Author contributions: Aldumour A and Aseni P contributed equally to this work; Aldumour A, Aseni P, Alkofahi M, De Carlis LG designed the research; Aldumour A, Lamperti L, Girotti P, Aldumour E analyzed the data; Girotti P and Lamperti L drew the pictures; Aldumour A, Aseni P, Alkofahi M wrote the paper.
Correspondence to: Paolo Aseni, MD, Department of Hepatobiliary Surgery and Liver Transplantation Unit, Niguarda Hospital, P.za Ospedale Maggiore 3, 20162 Milan, Italy. paolo.aseni@ospedaleniguarda.it
Telephone: +39-2-64442252
Fax: +39-2-64442893
Received: January 16, 2009
Revised: April 3, 2009
Accepted: April 10, 2009
Published online: May 14, 2009
Abstract

Iatrogenic bile-duct injury post-laparoscopic cholecystectomy remains a major serious complication with unpredictable long-term results. We present a patient who underwent laparoscopic cholecystectomy for gallstones, in which the biliary injury was recognized intraoperatively. The surgical procedure was converted to an open one. The first surgeon repaired the injury over a T-tube without recognizing the anatomy and type of the biliary lesion, which led to an unusual biliary mal-repair. Immediately postoperatively, the abdominal drain brought a large amount of bile. A T-tube cholangiogram was performed. Despite the contrast medium leaking through the abdominal drain, the mal-repair was unrecognized. The patient was referred to our hospital for biliary leak. Ultrasound and cholangiography was repeated, which showed an unanatomical repair (right to left hepatic duct anastomosis over the T-tube), with evidence of contrast medium coming out through the abdominal drain. Eventually the patient was subjected to a definitive surgical treatment. The biliary continuity was re-established by a Roux-en-Y hepatico-jejunostomy, over transanastomotic external biliary stents. The patient is now doing well 4 years after the second surgical procedure. In reviewing the literature, we found a similar type of injury but we did not find a similar surgical mal-repair. We propose an algorithm for the treatment of early and late biliary injuries.

Keywords: Biliary tract injury; Surgical complication; Biliary surgery; Laparoscopic cholecystectomy