Laparoscopic cholecystectomy is now a gold standard treatment modality for gallstone diseases. However, the incidence rate of bile duct injury has not been changed for many years. From initial classification published by Bismuth, there have been many classifications of common bile duct injury. The initial classification, levels and types of bile duct injury, and currently combined vascular injuries are reviewed here.
Bile Ducts ; Bismuth ; Cholecystectomy, Laparoscopic ; Classification* ; Common Bile Duct* ; Gallstones ; Incidence ; Vascular System Injuries

BACKGROUNDLaparoscopic cholecystectomy (LC) has been a standard operation and replaced the open cholecystectomy (OC) rapidly because the technique resulted in less pain, smaller incision, and faster recovery. This study was to evaluate the value of blunt dissection in preventing bile duct injury (BDI) in laparoscopic cholecystectomy (LC).

METHODSFrom 2003 to 2015, LC was performed on 21,497 patients, 7470 males and 14,027 females, age 50.3 years (14-84 years). The Calot's triangle was bluntly dissected and each duct in Calot's triangle was identified before transecting the cystic duct.

RESULTSTwo hundred and thirty-nine patients (1.1%) were converted to open procedures. The postoperative hospital stay was 2.1 (0-158) days, and cases (46%) had hospitalization days of 1 day or less, and 92.8% had hospitalization days of 3 days or less; BDI was occurred in 20 cases (0.09%) including 6 cases of common BDI, 2 cases of common hepatic duct injury, 1 case of right hepatic duct injury, 1 case of accessory right hepatic duct, 1 case of aberrant BDI 1 case of biliary stricture, 1 case of biliary duct perforation, 3 cases of hemobilia, and 4 cases of bile leakage.

CONCLUSIONExposing Calot's triangle by blunt dissection in laparoscopic cholecystectomy could prevent intraoperative BDI.

Adolescent ; Adult ; Aged ; Bile Duct Diseases ; prevention & control ; Cholecystectomy, Laparoscopic ; methods ; Common Bile Duct ; injuries ; surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

Flavobacterium odoratum is an obligately aerobic, gram-negative, non-fermentative rod. It has been infrequently isolated from urine, stool, wound, sputum, and blood specimens, but clinical infections caused by this organism are extremely rare. We report a case of bacteremic cholangitis caused by F. odoratum. The organism was simultaneously isolated in blood and bile from a patient, who had fever, sustained jaundice and abdominal pain with adenocarcinoma of the common bile duct. The isolated organism showed the typical biochemical characteristics. The results of antimicrobial sensitivity test showed resistance to aminoglycosides and cephalosporins but susceptibility to imipenem and trimethoprim-sulfamethoxazole.
Abdominal Pain ; Adenocarcinoma ; Aminoglycosides ; Bile ; Cephalosporins ; Cholangitis* ; Common Bile Duct ; Fever ; Flavobacterium* ; Humans ; Imipenem ; Jaundice ; Sputum ; Trimethoprim, Sulfamethoxazole Drug Combination ; Wounds and Injuries

PURPOSE: Single incision laparoscopic cholecystectomy (SILC) is generally performed with the use of inverse triangulation. In this study, we performed 3-channel or 4-channel SILC without the use of inverse triangulation. We evaluated the adequacy and feasibility of SILC using our surgical method. METHODS: We retrospectively reviewed our series of 309 SILCs performed between March 2014 and February 2015. RESULTS: Among 309 SILCs, male were 148 and female were 161 patients, mean age was 48.7 +/- 15.3 years old and mean body mass index was 24.8 +/- 3.8 kg/m2. Forty patients had previously undergone abdominal surgery including 6 cases of upper abdominal surgery. SILC after percutaneous transhepatic gallbladder (GB) drainage was completed in 8.7% of cases. There were 10 cases of emergency SILC. SILC was performed for noncomplicated GB including symptomatic GB stone and polyp in 66.7% of cases, acute cholecystitis in 33.3%. Overall, 96.8% of procedures were successfully completed without additional port. The reason for addition of an extra port or open conversion included technical difficulties due to severe adhesion and bleeding. The mean operating time was 60.7 +/- 22.3 minutes. The overall complication rate was 4.8%: 9 patients of wound seroma, 1 case of bile leakage from GB bed, 4 cases of intra-abdominal abscess or fluid collection, and 1 case of incisional hernia were developed. There was no case of common bile duct injury. CONCLUSION: Our surgical method of SILC without the use of inverse triangulation is safe, feasible and effective technique.
Abdominal Abscess ; Bile ; Body Mass Index ; Cholecystectomy, Laparoscopic* ; Cholecystitis, Acute ; Common Bile Duct ; Drainage ; Emergencies ; Female ; Gallbladder ; Hemorrhage ; Hernia ; Humans ; Laparoscopy ; Male ; Polyps ; Retrospective Studies ; Seroma ; Wounds and Injuries

A 6-year-old male who lived with a mother in a single-parent family was referred to the emergency room with multiple traumas. There was no specific finding on CT scan of the other hospital performed 55 days before admission. However, CT scan at the time of admission showed common bile duct (CBD) stenosis, proximal biliary dilatation and bile lake formation at the segment II and III. Endoscopic retrograde biliary drainage was performed, but the tube had slipped off spontaneously 36 days later, and follow-up CT scan showed aggravated proximal biliary dilatation above the stricture site. He underwent excision of the CBD including the stricture site, and the bile duct was reconstructed with Roux-en-Y hepaticojejunostomy. Pathologic report of the resected specimen revealed that the evidence of trauma as a cause of bile duct stricture. While non-iatrogenic extrahepatic biliary trauma is uncommon, a level of suspicion is necessary to identify injuries to the extrahepatic bile duct. The role of the physicians who treat the abused children should encompass being suspicious for potential abdominal injury as well as identifying visible injuries.
Abdominal Injuries ; Bile Ducts ; Bile Ducts, Extrahepatic ; Bile ; Child ; Child Abuse ; Child ; Common Bile Duct ; Constriction, Pathologic ; Dilatation ; Drainage ; Emergency Service, Hospital ; Follow-Up Studies ; Humans ; Lakes ; Male ; Mothers ; Multiple Trauma ; Single-Parent Family ; Tomography, X-Ray Computed ; Wounds, Nonpenetrating

A 72-year-old man with jaundice by ampullary adenocarcinoma was treated at our hospital. For biliary decompression, a transpapillary, fully covered, self-expandable metal stent (FCSEMS) was deployed. Four days later, the patient developed acute cholangitis. Endoscopic carbon dioxide cholangiography revealed kinking of the common bile duct above the proximal end of the FCSEMS. A 7-F double-pigtail plastic stent was therefore placed through the FCSEMS to correct the kink, straightening the common bile duct (CBD) and improving cholangitis. This is the first report of a unique use of a double-pigtail plastic stent to correct CBD kinking. The placement of a double-pigtail plastic stent can correct CBD kinking, without requiring replacement or addition of a FCSEMS, and can lead to cost savings.
Aged ; Common Bile Duct/*injuries ; Constriction, Pathologic/surgery ; Decompression, Surgical/instrumentation/methods ; Humans ; Male ; Self Expandable Metallic Stents/adverse effects ; *Stents ; Torsion Abnormality/*surgery

The laparoscopic cholecystectomy has been rapidly accepted as the standard treatment for gallbladder stones because its minimally invasive nature offers a significant advantage over an open cholecystectomy in terms of postoperative morbidity & recovery. The endoscopic sphinterotomy has become the primary treatment for common bile duct stones, yielding a duct clearance rate of approximately 90%. The laparoscopic cholecystectomy combined with the preoperative endoscopic sphinterotomy is becoming more widely employed as a therapeutic option for the management of gallbladder stones & common bile-duct stones. The authors retrospectively analyzed 71 patients who had been treated by an open cholecystectomy and a common bile-duct exploration (group A) and 35 patients who had been treated by a laparoscopic cholecystectomy plus endoscopic sphinterotomy (group B) at the Department of Surgery, Jungang Gil Hospital, from March 1993 to January 1996. The diagnotic procedures performed were ultrasonography ERC and DISIDA scan, and abdominal computed tomography. Intraoperative cholangiograms were successfully performed in 59 cases from group A and in 5 cases from group B. Successful duct clearance was achieved in 87.3% of the group A cases and in 87.5% of the group B cases. The operation time, the postoperative hospital stay, and postoperative complications were significantly lower for group B than for group A. The major postoperative complication was wound pain & infection for both groups. We conclude that in comparison with group A, group B appeared to have a similar clearance rate, a much lower morbidity, a shorter hospital stay, an earlier return to working fitness, and a better cosmetic result.
Cholecystectomy ; Cholecystectomy, Laparoscopic ; Choledocholithiasis* ; Cholelithiasis* ; Common Bile Duct ; Gallbladder ; Humans ; Length of Stay ; Postoperative Complications ; Retrospective Studies ; Return to Work ; Ultrasonography ; Wounds and Injuries

OBJECTIVETo investigate the early diagnosis on iatrogenic injuries in distal part of common bile duct and the prevention of severe retroperitoneal infection.

METHODSFrom 1990 to 2004, 17 patients with bile duct injures in the distal part of common biliary tract were admitted. And the clinical data of the 17 cases were retrospectively analyzed.

RESULTSOf the 17 cases, the injuries of 15 cases were caused by the operation, and the injuries of the other 2 cases were caused in the process of removing the stone by endoscopic retrograde cholangiopancreatography (ERCP). The injuries of 14 cases were found during the operation, but the other one was not found in time. Before the operation, 16 cases were examined by B-type ultrasonography, 2 by MRCP and 6 by intraoperative choledocho-endoscope after the biliary tract exploration. Ten cases underwent perforating suture repair and T-tube drainage; 2 with Odd's sphincter incision and shaping; 2 with choledochojejunostomy; 1 with duodenum wall and bile duct repair and drainage. When the bile duct injured, the major findings during operation were bile duct explorer located out of the duodenum wall and bile duct, two or more than cleft in the distal part of common biliary tract found by choledocho-endoscopic examination, retroperitoneal edema and liquid accumulation found by irrigating water through T-tube, and/or retroperitoneal tissues stained blue by irrigating methylthioninium chloride through T-tube. The clinical manifestations after injuries were abdominal distention, abdominal pain, pain in the waist and back, fever and shock, et al. Thirteen cases were cured. And the syndromes included 1 case with intestinal fistula, 1 with incisional infection, 4 dead (3 died from infectious shock; 1 from bleeding in gastrectomy).

CONCLUSIONSThe postoperative clinical manifestations for iatrogenic injuries in the distal part of common biliary tract lack specificity, CT examinations are necessary to doubtful patients. Early diagnosis and timely management can obtain better results, and can effectively lower severe retroperitoneal infection. The perfect preoperative imaging examinations and intraoperative choledocho-endoscopic examinations before the biliary tract exploration maybe reduce iatrogenic injuries in the distal part of common biliary tract.

Adult ; Aged ; Common Bile Duct ; injuries ; surgery ; Female ; Humans ; Iatrogenic Disease ; prevention & control ; Intraoperative Complications ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Peritonitis ; prevention & control ; Radiography ; Retrospective Studies

INTRODUCTIONBile duct perforation (BDP) with resultant biliary ascites in children is a rare clinical condition. The aetiopathogenesis is still an enigma, with increasing evidence suggesting anomalous union of pancreaticobiliary ductal (AUPBD) system as the prime causative factor.

CLINICAL PICTUREWe report 2 cases of spontaneous perforation of the bile duct confirmed on histopathological examination as choledochal cyst, in a 6-month-old female child and a 4-year-old boy who presented with subtle clinical symptoms.

TREATMENT AND OUTCOMEBoth patients were successfully managed by excision of the gall bladder and common bile duct and Roux-en- Y hepaticojejunostomy. This procedure was performed following initial cholecystostomy drainage in the second case.

CONCLUSIONSFrom the available literature and experience with our patients, BDP is not merely spontaneous but may be related to AUPBD and choledochal cyst.

Ascites ; etiology ; surgery ; Bile Ducts ; injuries ; Child, Preschool ; Cholangiography ; Cholecystectomy ; Choledochal Cyst ; complications ; surgery ; Common Bile Duct ; diagnostic imaging ; injuries ; surgery ; Female ; Humans ; Infant ; Jejunostomy ; Laparoscopy ; Male ; Tomography, X-Ray Computed

Klebsiella ornithinolytica is a very rare Klebsiella species isolated from human. Human strains have been isolated mainly from respiratory secretions, wounds and urine. The clinical features and pathogenic role of human disease with K. ornithinolytica is unknown. We describe a case of K. ornithinolytica bacteremia which developed in a 45-year-old man with acute cholangitis by common bile duct stones. In this case, K. ornithinolytica was sensitive to beta-lactamase inhibitor, all tested cephalosporins, aminoglycosides, quinolones, trimethoprim/sulfameth- oxazole but resistant to ampicillin. After intravenous therapy with cefotaxime, follow up blood culture showed no further growth of K. ornithinolytica. Later, extended-spectrum beta-lactamase (ESBL) producing Klebsiella pneumoniae and Escherichia coli was cultured from bile, so the antibiotics was switched to meropenem. Common bile duct stones was removed by percutaneous transhepatic cholangioscopy (PTCS) and the patient recovered fully without any complication.
Aminoglycosides ; Ampicillin ; Anti-Bacterial Agents ; Bacteremia* ; beta-Lactamases ; Bile ; Cefotaxime ; Cephalosporins ; Cholangitis ; Common Bile Duct ; Escherichia coli ; Follow-Up Studies ; Humans ; Klebsiella pneumoniae ; Klebsiella* ; Middle Aged ; Quinolones ; Wounds and Injuries