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An option of conservative management of a duodenal injury following laparoscopic cholecystectomy.

Modi M, Deolekar S, Gvalani A - Case Rep Surg (2014)

Bottom Line: Most injuries are attributed to thermal burns with electrocautery following adhesiolysis and have a delayed presentation requiring surgical intervention.We present a case of a 47-year-old gentleman operated on for laparoscopic cholecystectomy with a bilious drain postoperatively; for which an ERC was done showing choledocholithiasis with cystic duct stump blow-out and a drain in the duodenum suggestive of an iatrogenic duodenal injury.He was managed conservatively like a duodenal fistula and recovered without undergoing any intervention.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Parel, Mumbai 400012, India.

ABSTRACT
Duodenal injury following laparoscopic cholecystectomy is rare complications with catastrophic sequelae. Most injuries are attributed to thermal burns with electrocautery following adhesiolysis and have a delayed presentation requiring surgical intervention. We present a case of a 47-year-old gentleman operated on for laparoscopic cholecystectomy with a bilious drain postoperatively; for which an ERC was done showing choledocholithiasis with cystic duct stump blow-out and a drain in the duodenum suggestive of an iatrogenic duodenal injury. He was managed conservatively like a duodenal fistula and recovered without undergoing any intervention.

No MeSH data available.


Related in: MedlinePlus

Tube conray gram showing the dye filling up in the duodenum without evidence of any intraperitoneal leak.
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fig4: Tube conray gram showing the dye filling up in the duodenum without evidence of any intraperitoneal leak.

Mentions: A 47-year-old gentleman had a 10-day history of painful obstructive jaundice. Ultrasonography revealed chronic cholecystitis with choledocholithiasis. EUS revealed a slightly dilated common bile duct (CBD) 9 mm with multiple stones impacted just above the ampulla in the lower CBD with multiple gall stones. ERC with sphincterotomy, stone extraction, and stent placement was done; complete clearance was achieved. A month later, he underwent laparoscopic cholecystectomy at a community hospital; intraoperatively he had dense omental adhesions around Calot's triangle which were separated and the wide cystic duct was identified and clipped. In view of bleeding, while adhesiolysis a drain was placed postoperatively. On the second postoperative day, the drain was bilious in nature and was referred to our centre for further management. On arrival he was vitally stable with minimal epigastric tenderness and had a bilious drain. A CT scan done revealed a drain in the second part of the duodenum (Figure 1). We sent the patient for ERC in view of suspected duodenal and biliary injury (Figure 2). Duodenoscopy revealed the tip of the drain at the junction of D1-D2, previous stent was removed, and cholangiogram revealed mid-CBD calculi with cystic duct stump blow-out (Figure 3). Stone extraction was done and another stent was placed. The patient did not show any signs of sepsis; hence we managed him conservatively with the drain behaving like a tube duodenostomy with a daily output of around 200 mL. He was started on orals which he tolerated well. A conray gram done after 3 weeks, through the drain, showed no intraperitoneal leak and free flow of contrast into the duodenum (Figure 4). The drain was clamped and removed and this was followed by CBD stent removal (Figure 5). On 6-month follow-up, he is doing well.


An option of conservative management of a duodenal injury following laparoscopic cholecystectomy.

Modi M, Deolekar S, Gvalani A - Case Rep Surg (2014)

Tube conray gram showing the dye filling up in the duodenum without evidence of any intraperitoneal leak.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4221966&req=5

fig4: Tube conray gram showing the dye filling up in the duodenum without evidence of any intraperitoneal leak.
Mentions: A 47-year-old gentleman had a 10-day history of painful obstructive jaundice. Ultrasonography revealed chronic cholecystitis with choledocholithiasis. EUS revealed a slightly dilated common bile duct (CBD) 9 mm with multiple stones impacted just above the ampulla in the lower CBD with multiple gall stones. ERC with sphincterotomy, stone extraction, and stent placement was done; complete clearance was achieved. A month later, he underwent laparoscopic cholecystectomy at a community hospital; intraoperatively he had dense omental adhesions around Calot's triangle which were separated and the wide cystic duct was identified and clipped. In view of bleeding, while adhesiolysis a drain was placed postoperatively. On the second postoperative day, the drain was bilious in nature and was referred to our centre for further management. On arrival he was vitally stable with minimal epigastric tenderness and had a bilious drain. A CT scan done revealed a drain in the second part of the duodenum (Figure 1). We sent the patient for ERC in view of suspected duodenal and biliary injury (Figure 2). Duodenoscopy revealed the tip of the drain at the junction of D1-D2, previous stent was removed, and cholangiogram revealed mid-CBD calculi with cystic duct stump blow-out (Figure 3). Stone extraction was done and another stent was placed. The patient did not show any signs of sepsis; hence we managed him conservatively with the drain behaving like a tube duodenostomy with a daily output of around 200 mL. He was started on orals which he tolerated well. A conray gram done after 3 weeks, through the drain, showed no intraperitoneal leak and free flow of contrast into the duodenum (Figure 4). The drain was clamped and removed and this was followed by CBD stent removal (Figure 5). On 6-month follow-up, he is doing well.

Bottom Line: Most injuries are attributed to thermal burns with electrocautery following adhesiolysis and have a delayed presentation requiring surgical intervention.We present a case of a 47-year-old gentleman operated on for laparoscopic cholecystectomy with a bilious drain postoperatively; for which an ERC was done showing choledocholithiasis with cystic duct stump blow-out and a drain in the duodenum suggestive of an iatrogenic duodenal injury.He was managed conservatively like a duodenal fistula and recovered without undergoing any intervention.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Parel, Mumbai 400012, India.

ABSTRACT
Duodenal injury following laparoscopic cholecystectomy is rare complications with catastrophic sequelae. Most injuries are attributed to thermal burns with electrocautery following adhesiolysis and have a delayed presentation requiring surgical intervention. We present a case of a 47-year-old gentleman operated on for laparoscopic cholecystectomy with a bilious drain postoperatively; for which an ERC was done showing choledocholithiasis with cystic duct stump blow-out and a drain in the duodenum suggestive of an iatrogenic duodenal injury. He was managed conservatively like a duodenal fistula and recovered without undergoing any intervention.

No MeSH data available.


Related in: MedlinePlus