Iatrogenic bile duct injury delayed repair and treatment of complications – case report

Background: With the increase of laparoscopic cholecystectomies performed in Poland, the occurrence of complications also rises. Many surgery departments still do not refer patients with bile duct injuries to hepatobiliary centers or do so with delay. Methods: A 72 yr. female H. M. with, jaundice, fever, pain in the upper abdomen, after 5 laparotomies and 1 ERCP, with a biliary fistula and extrahepatic drainage was admitted to the Center after 12 months of hospitalization at another facility in Poland. In May 2011 an open cholecystectomy was performed after a laparoscopic conversion due to cholecystitis. The patient was transferred with a persistent duodenal fistula secreting about 400ml content daily and bilirubin concentration = 6.45 mg. During the next 5 weeks the patient was treated pharmacologically and rehabilitated prior to surgery. After the improvement of nutritional status and body weight increase, the patient underwent surgery. Results: Early post-surgery complications were limited to a duodenal fistula treated successfully during 6 consecutive weeks. Control cholangiography gave no evidence of anastomosis leakage and abdominal ultrasound showed no abnormal fluid collections. The patient was nourished orally and discharged from hospital in good general condition after 118 days. Conclusion: Complications that occur must be attended to with adequate resources in the appropriate time and optimal conditions according to HPB consensus guidelines. Any other conduct may be harmful for patients and cost-ineffective.