Biliary injury (bile duct injury) is the traumatic damage of the bile ducts. It is most commonly an

iatrogenic Iatrogenesis is the causation of a disease, a harmful complication, or other ill effect by any medical activity, including diagnosis, intervention, error, or negligence." Iatrogenic", ''Merriam-Webster.com'', Merriam-Webster, Inc., accessed 27 ...

complication of

cholecystectomy Cholecystectomy is the surgical removal of the gallbladder. Cholecystectomy is a common treatment of symptomatic gallstones and other gallbladder conditions. In 2011, cholecystectomy was the eighth most common operating room procedure performed i ...

(surgical removal of the

gallbladder In vertebrates, the gallbladder, also known as the cholecyst, is a small hollow Organ (anatomy), organ where bile is stored and concentrated before it is released into the small intestine. In humans, the pear-shaped gallbladder lies beneath t ...

), but can also be caused by other operations or by

major trauma Major trauma is any injury that has the potential to cause prolonged disability or death. There are many causes of major trauma, blunt and penetrating, including falls, motor vehicle collisions, stabbing wounds, and gunshot wounds. Dependi ...

. The risk of biliary injury is higher during laparoscopic cholecystectomy than during open cholecystectomy. Biliary injury may lead to several complications and may even cause death if not diagnosed in time and managed properly. Ideally biliary injury should be managed at a center with facilities and expertise in

endoscopy An endoscopy is a procedure used in medicine to look inside the body. The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are insert ...

radiology Radiology ( ) is the medical specialty that uses medical imaging to diagnose diseases and guide treatment within the bodies of humans and other animals. It began with radiography (which is why its name has a root referring to radiation), but tod ...

and surgery.

Signs and symptoms

Only about 25 to 40% of bile duct injuries are detected intraoperatively. A biliary stricture, leak, or obstruction may be the injury's outward manifestation. A history of

empyema or gangrenous

cholecystitis Cholecystitis is inflammation of the gallbladder. Symptoms include Right upper quadrant (abdomen), right upper abdominal pain, pain in the right shoulder, nausea, vomiting, and occasionally fever. Often gallbladder attacks (biliary colic) precede ...

as reasons for

should raise the possibility of biliary injury. If the bile duct injury is not recognized right away, the patient may present with bile in the drain, if one was left in place. Otherwise, bile may drain from the incision. Postoperative symptoms of biliary injury include

fever Fever or pyrexia in humans is a symptom of an anti-infection defense mechanism that appears with Human body temperature, body temperature exceeding the normal range caused by an increase in the body's temperature Human body temperature#Fever, s ...

, vague pain in the abdomen,

nausea Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. It can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of the throat. Over 30 d ...

pruritis An itch (also known as pruritus) is a sensation that causes a strong desire or reflex to scratch. Itches have resisted many attempts to be classified as any one type of sensory experience. Itches have many similarities to pain, and while both ...

, and failure to tolerate diet.

Causes

Biliary tract injuries caused by trauma are uncommon. Intrahepatic injuries occur in conjunction with hepatic injuries in blunt (crushing injuries, direct blows to the abdomen, falls from great heights, vehicular accidents) or penetrating (stabbing and gunshot wounds) abdominal trauma. The prevalence of bile leaks, or biliary injuries, in liver trauma is estimated to be between 4 and 23%. Iatrogenic injuries are most commonly seen during laparoscopic cholecystectomy. After conventional open cholecystectomy, the rate of clinically significant bile leaks ranges between 0.1 and 0.3%. Whereas, biliary leakages have increased by up to 3% in the era of laparoscopic cholecystectomy. There are numerous factors that can cause those injuries, including the surgeon's, endoscopist's, or radiologist's inexperience, anatomical variations in the region, which are common, inflammation of the

and surrounding tissue, which is the most common factor causing error, and as a result injury to the bile duct.

References

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Signs and symptoms

Causes

References

See also