Biliary duct injury
Bile duct injury:
multidisciplinary managmenent with hepatobiliary surgery, IR, and G.
Aberrant biliary anatomy is common:
Right hepatic artery commonly injured. Blood supply should be investigated also. Ischemic cholangitis is a possibility.
A- most common, cystic duct leak from poor occlusion or leak from peripheral liver bed branch. ERCP treats this type best but does not give you information on occluded ducts. Percutaneous drainage of biloma. Will usually heal.
B - occluded aberrant right duct, possible surgical resection of affected lobe. Typically with left lobe hypertrophy.
C - transaction without ligation of an aberrant right duct. surgery
D - lateral CBD sidewall injuries, managed with stenting.
E- Any injury to the intrahepatic bile ducts. multiple subtypes. Percutaneous drainage to control sepsis. Identification of all ducts is key.
Definitive surgery best done 2-3 months after initial injury and extent of ischemic injury is clear. Hepaticojejunostomy with side to side anastomoses of via the horizontal portion of the left hepatic duct and the jejunum.
After biloma is drained and scars in, do sinus duct injection after waiting to opacity the bile ducts.
Biliary U-tube is a good solution for drain stability, provides drainage, gives surgeon a marker during surgical reconstruction.