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Bile Duct Reconstructions

Bile duct reconstructions are done for injuries to the bile duct.

Bile duct injuries can result from blunt or penetrating external trauma or from inadvertent injury during surgical operations, most commonly cholecystectomy, the operation to remove the gallbladder. The injury may be associated with injuries to the hepatic artery or portal vein, the major blood vessels carrying blood to the liver. The severity and complexity of the injury ranges from a relatively minor, isolated injury to the main bile duct to complex combined injuries to the bile ducts and blood vessels in the hilum of the liver.

The less complex injuries may be managed by insertion of a stent into the bile duct, either endoscopically from within the duodenum or by puncture through the abdominal wall and liver.

More complicated injuries require anastomosis of an isolated segment of upper small bowel (Roux loop) to the bile duct at its emergence from the liver, sometimes together with removal of part of the liver.

In cases where the injury is diagnosed early, immediate reconstruction can be done, but if the diagnosis has been delayed and infection has become established, it may be safer to insert drains into the peritoneal cavity and bile ducts and treat with antibiotics for a variable period before doing a delayed reconstruction. These complicated cases will also need careful nutritional replenishment, with special reference to replacement of fat-soluble vitamins (A, D, E & K).

Common hepatic duct transection 

                                High Injury   Transected bile duct prpared for anastomosis to jejunum    

Bowel anastomosed to bile duct

 

  Sequelae of Delayed / Complicated ReconstructionRight liver necrotic / atrophied 

      Strictured choledochoenterostomy