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

Figure 1 Computed tomography scan. A: Initial computed tomography scan of the abdomen revealing a 3 cm biloma at the gallbladder fossa with bile tracking into the sub-hepatic recess; B: Multiple rim-enhancing smaller intra-abdominal collections were also present in the upper abdomen; C: The largest intra-abdominal collection was a 9.3 cm × 8.5 cm perisplenic collection.

Figure 2 Endoscopic retrograde cholangiography. A: Endoscopic retrograde cholangiography revealed a large Strasberg Type D common hepatic duct defect with contrast seen immediately in the sub-hepatic recess; B: Plastic biliary stents inserted across the biliary defect into the left and right hepatic ducts.

Figure 3 Damage control surgery. A: At the time of exploratory laparotomy, endoscopically placed biliary stents were visible within a large 2 cm anterolateral common hepatic duct defect; B: A pedicled omental patch was harvested and secured to the biliary defect using absorbable sutures.

Figure 4 An illustration of the pedicled omental patch. A: An illustration showing the location of the common hepatic duct defect and endoscopic biliary stents placed across; B: The harvested pedicled omental patch was placed over the biliary defect and secured using absorbable sutures that run through the anterior and posterior margins of the biliary defect.