Bile duct injury in an anatomical variant of the posterior right hepatic duct draining in the cystic duct: case report
DOI:
https://doi.org/10.18203/2320-6012.ijrms20221996Keywords:
Strasberg classification, MRCP imaging, Surgical case reports, Biliary tree variants, Post cholecystectomy BDIAbstract
During laparoscopic cholecystectomy, several factors increase the likelihood of bile duct injury (BDI). The most common cause of BDI during laparoscopic cholecystectomy is an inappropriate identification of the critical view of safety associated with acute and chronic inflammation, obesity, haemorrhage, and anatomical variants. Of all anatomic variants of the biliary tree, Blumgart type F has been reported as the least common, but allegedly it carries the biggest risk of BDI. We present the case of a 45-year-old woman with acute cholecystitis subjected to laparoscopic cholecystectomy with Strasberg type C injury in association with a Blumgart F variation confirmed by magnetic resonance cholangiopancreatography. The anatomical variant was identified during the surgical procedure but the BDI was diagnosed postoperatively. Intraoperative identification and treatment of the injury confers a better prognosis to the patient. Management of a BDI on a Blumgart F variant can be challenging and must be targeted to the individual case. Safety measures to prevent such injuries must be promoted by institutions.
References
Renz BW, Bösch F, Angele MK. Bile Duct Injury after Cholecystectomy: Surgical Therapy. Visc Med. 2017;33(3):184-90.
Stewart L. Iatrogenic biliary injuries: Identification, classification, and management. Surg Clin North Am. 2014;94(2):297-310.
Tolino MJ, Tartaglione AS, Sturletti CD, García MI. Variedades Anatómicas del Árbol Biliar: Implicancia Quirúrgica. Int J Morphol. 2010;28(4):1235-40.
Magdaleno M, Barrón O, Hernández J, Amador M, Meléndez M. Conducto cístico con desembocadura en hepático derecho: Reporte de un caso. Rev Mex Cir Endosc. 2018;19(1):17-20.
Nari GA, Viotto L, Gil F, Lamoratta F, Layún J, Arias A, et al. Lesión quirúrgica de la vía biliar de la variante anatómica de la confluencia tipo F. Importancia de la colangiografía intra-operatoria sistemática y las alternativas terapéuticas. Acta Gastroenterol Latinoam. 2015;45(4):303-6.
González D, Tristant M. Variación anatómica de la vía biliar tipo F de Blumgart. An Fac Med (Univ Repúb Urug). 2021;8(2):e701.
Stewart L, Way LW. Laparoscopic bile duct injuries: Timing of surgical repair does not influence success rate. A multivariate analysis of factors influencing surgical outcomes. HPB. 2009;11(6):516-22.
Wakabayashi G, Iwashita Y, Hibi T, Takada T, Strasberg SM, Asbun HJ et al. Tokyo Guidelines 2018: surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2018;25:73-86.
Khatiwada S, Adhikari BN, Iju S. Anatomical variation of intrahepatic biliary duct in cadaveric liver. J Chitwan Med Coll. 2019;6(34):2299-305.
Mutignani M, Dioscoridi L, Pugliese F, Cintolo M, Massad M, Forti E. Primary endotherapy for Strasberg type C bile leaks. Surgery. 2019;166(3):286-9.
