Duodenal injury post laparoscopic cholecystectomy: Incidence, mechanism, management and outcome

Table 1 Literature review-duodenal injury post laparoscopic cholecystectomy: Demographic details, presentation and investigations

Ref.	Nature of study	No. of DuI/No. of LC (%)	Age (yr)mean range	Gender	Time of diagnosis From LC in days	Presentation	Investigations
Modi et al[8]	CR	1	47	M	2	BDr-1	CT-1
							Fist-1
							Gasc-1
Jing et al[9]	CR	1	74	M	4	Fever	CT-1
							BA-St-1
							US-asp-1
Yajima et al[26]	CS	1/407	NA	NA	Immed-day 0	NA	NA
Testini et al[6]	CS	5	59 (49-51)	M-4	Immed-1-day 0	Fever-2	Amyd-1
				F-1	1st day-1	Tachycardia-1	CT-4
					3rd day-1	Leukocytosis
					4th day-1	Rigidity/vomiting
					5th day-1	Sshock-2
Singh[10]	CS	3/1748 (0.17%)	33 (23-45)	F-3	Immed-2	Fever	CT-2
					2nd day-1	Abd. pain
Avrutis et al[24]	CR	1	NA	NA	9th day	Haemtemesis	NA
						Intra-abd abscess
Kwon et al[11]	CS	2/1190	50	M-2	NA	NA	NA
			68
El-Banna et al[7]	CS	4/NA	32-73	M = 2	Immed-1-day 0	Sshock-2 (4 d)	X-ray abd
			47	F = 2	3rd day-1	Local peritonitis-1	CT
					4th day-2	Diffuse peritonitis-1	US abd
Bishoff et al[30]	CS	1/915	NA	NA	NA	NA	NA
Croce et al[12]	CS	4/2100 (0.2%)	50 (45-56)	M = 1	Immed = 2 -day 0	Abd pain = 4	US asp-2
				F = 3	2nd day = 2	Tachycardia leukocytosis	CT = 2
						Rigidity = 1 vomiting	Gastrffin = 2
							Amyd = 2
							Relapsc = 4
Roviaro et al[13]	CS	1/1005 (0.09%)	NA	NA	NA	NA	NA
Huang[14]	CS	19/39238 (0.04%)	NA	NA	NA	NA	NA
Wherry et al[2]	CS	4/9130 (0.04%)	NA	NA	NA	NA	NA
Schrenk et al[15]	CS	2/1690 (0.1%)	70 80	F = 2	Immed = 2 –day 0	NA	NA
Chen et al[17]	CS	1/2428 (0.04%)	NA	NA	Immed = 1 -day 0	Immed = 1	Immed = 1
Kum et al[16]	CS	1/25 (4%)	NA	NA	Immed = 1 –day 0	Immed = 1	Immed = 1
Cala et al[19]	CS	1/1000 (0.01%)	NA	NA	NA	NA	NA
Baev et al[20]	CS	1/700 (0.14%)	NA	NA	NA	NA	NA
Yamashita et al[21]	CS	1/1054 (0.09%)	42	F	Immed = -day 0	Immed = 1	Immed = 1
Berry et al[25]	CR	1	76	F	6th day	Tachycardia, tachypnea, nausea, vomiting, leukocytosis	CT
Ward et al[18]	CS	1/NR	NA	NA	NA	NA	NA
Ress et al[4]	CS	3/NA	NA	NA	Immed = 1 -day 0	Sshock = 1	CT
					Ist day = 1	Abd pain = 1	US
					4th day = 1	Immed = 1
Deziel et al[5]	CS	12/77.604 (0.01%)	NA	NA	NA	NA	NA
Peters et al[23]	CS	2/283 (0.7%)	NA	NA	NA	NA	NA

LC: Laparoscopic cholecystectom; CR: Case report; CS: Case series; Immed: Immediate (on table); CT: Computerised tomography; US: Ultrasound abdomen; Fist: Fistulogram; BA-St: Barium study; DuI: Duodenal injuries; Gasc: Gastroscopy; AmyD: Amylase level in draining fluid; US asp: Ultrasound guided aspiration; BDr: Bile drainage from drain; Abd: Abdominal; Sshock: Septic shock; Relaps: Relaparoscopy; Gastrffin: Gastrograffin study; NA: Not available; M: Male; F: Female.

Table 2 Literature review on duodenal injury post laparoscopic cholecystectomy: Surgery details and outcome

Series	Site of injury	Cause of injury	Nature of surgery	Day of detection and outcome
Modi et al[8]	D1/D2 junction	BlDis-1	Conservative - US guided aspiration of collection = 1	2nd day - survived
Jing et al[9]	D1 = diverticulum	NA	Conservative - percutaneous drain = 1	4th day - survived
Yajima et al[26]	NA	NA	NA	NA
Testini et al[6]	D2A-2	BlDis-2	Duodenorapphy + t tube = 2	Immed-day 0 - survived
	D2B-2	Caut-3	Petzer t tube = 1	1st day = survived
	D3-1		Gastric resection = 1	3rd day = survived
			Whipple resection = 1	4th day = survived
				5th day = died
Singh et al[10]	NA	Bl Dis-3	Duodenorapphy = 3	Immed-day 0 - survived
				Immed-day 0 - survived
				2nd day = survived
Avrutis et al[24]	NA	NA	NA	NA
Kwon et al[11]	NA	Bl Dis-2	Laparoscopic Endo GI closure = 1
			Laparoscopic intracorporeal suturing = 1	Day of injury = NA
				Survived
El-Banna et al[7]	NA	Caut-4	Precutaneous drain = 1	Immed-day 0 - died
			Gastrectomy + duodenostomy = 2	3rd day = survived
			Serosal patch = 1	4th day = died
				4th day = died
Bishoff et al[30]	NA	Bl Dis- scissors	Laparotomy duodenorapphy = 1	NA
Croce et al[12]	D1 = 2	Retraction = 3	Laparoscopic - intracorporeal suturing = 2	Immed-day 0 = survived
	D2 = 2	Caut = 1	Laparotomy = duodenorapphy + omental patch	Immed-day 0 = survived
			Relaproscopy = missed injury, conservative (NPO/TPN/somataostatin) = 1	2nd day = survived
				2nd day = survived
Roviaro et al[13]	NA	NA	NA	NA
Huang et al[14]	NA	NA	NA	NA
Wherry et al[2]	NA	NA	NA	Day of injury = NA
				Survived = 3
				Died = 1
Schrenk et al[15]	NA	Caut = 1	Duodenorapphy = 2	Immed-day 0 = survived
		Bl Dis = 1		Immed-day 0 = survived
Chen et al[17]	NA	NA	NA	NA
Kum et al[16]	NA	Caut = 1	Laparoscopy + duodenorapphy = 1	Immed-day 0 = survived
Cala et al[19]	NA	NA	NA	NA
Baev et al[20]	NA	NA	Laparotomy + duodenorapphy = 1	NA
Yamashita et al[21]	NA	Retraction	Laparotomy + duodenorapphy = 1	Immed-day 0 = survived
Berry et al[25]	D2A	Caut = 1	T tube duodenostomy + pyloric exclusion + gastrojejunostomy	6th day = survived
Ward et al[18]	NA	NA	NA	NA
Ress et al[4]	NA	Caut = 2	Laparoscopy + serosal tear repair	Immed = day 0 = survived
		Bl dis = 1	Laparotomy + duodenorapphy = 2	Ist day = 1 = survived
				4th day = 1 = died
Deziel et al[5]	NA	NA	Laparotomy = 12 (details NA)	Day of injury = NA
				Survived = 11
				Died = 1
Peters et al[23]	NA	NA	NA	NA

D1: Superior flexure; D2A: Above duodenal papilla; D2B: Below duodenal papilla; D3: Inferior flexure; Bl Dis: Blunt dissection; Caut: Electrocautery; NA: Not available; US: Ultrasound abdomen; GI: Gastrointestinal; Immed: Immediate (on table detection); NPO: Nil per oral; TPN: Total parenteral nutrition.

Table 3 Distribution of mortality status by days of detection of injury

Days of detection of injury	Injury detection status				Total
	Alive		Dead
	n	%	n	%
0	12	100	0	0.0	12
1	2	66.7	1	33.3	3
2	2	50.0	2	50.0	4
≥ 3	6	66.7	3	33.3	9
Total	22	78.6	6	21.4	28