A Case of the Biliary Duct Injury in Laparoscopic Cholecystectomy: Classical But Still Necessary Reminder

Takuya Sugimoto, MD, Kenju Ko, MD, PhD, Hiroshi Nagata, MD, Nobuyasu Kano, MD, PhD, FACS

KAMEDA MEDICAL CENTER

[INTRODUCTION] Biliary injury is one of the head-aching complications in laparoscopic cholecystectomy. To avoid this complication, surgeons always try to identify the duct by keeping ‘the critical view of safety’ in mind. However, this bothering complication occurs under some condition. We experienced a case of complete transection followed by reconstruction of the common bile duct.

[Procedures] A fifty-nine year-old woman was diagnosed as acute cholecystitis and underwent percutanous trans-hepatic gall bladder drainage (PTGBD). On the sixth day from the onset, she underwent laparoscopic cholecystectomy. Gall bladder was so severely inflamed that it was completely difficult to identify the structure of the Calot’s triangle. Unfortunately, the common bile duct was misidentified as the cystic duct, and transected by a linear stapler. After transection, we recognized misidentification by cholangiography through PTGBD tube during the operation, and converted to open procedure. The common bile duct was reconstructed by Roux-en-Y hepaticojejunostomy.

[Results] The postoperative course was uneventful.

[Conclusion] We presented this case to remind all surgeons of this complication.

Session: Poster Presentation

Program Number: P599