Pedicled omental patch as a bridging procedure for iatrogenic bile duct injury

Abstract

Iatrogenic bile duct injuries during cholecystectomy can present as fulminant intra-abdominal sepsis which precludes immediate repair or biliary reconstruction. We report the case of a 29-year-old female patient who sustained a bile duct injury after an open cholecystectomy in a neighboring country. She presented to our institution 22 d after initial surgery with septic shock and multiple intra-abdominal collections. Endoscopic retrograde cholangiography revealed a large common hepatic duct defect corresponding to a Strasberg type D bile duct injury. Definitive reconstruction such as a hepaticojejunostomy cannot be performed due to the presence of dense adhesions with infected and friable tissues. She underwent a combination of endoscopic biliary stenting and pedicled omental patch repair of the bile duct to control bile leak and sepsis as a bridging procedure to definite hepaticojejunostomy three months later.

Keywords: Cholecystectomy; Endoscopic retrograde cholangiopancreatography; Case reports; Bile ducts; Abdominal abscess

Core tip: Iatrogenic bile duct injury is a challenging condition to treat. This case report describes a novel and innovative surgical technique, whereby a pedicled omental patch repair was performed as a bridging procedure to definitive repair such as a hepaticojejunostomy, in a patient who presented in a delayed fashion with severe intra-abdominal sepsis.