Clinical Analysis Of Bile Duct Injury During Laparoscopic Cholecystectomy

A 70-year-old man was referred to our hospital for gradual aggravating jaundice with hidden pain after laparoscopic cholecystectomy for 4 days. Significant past history included chronic cholecystolithiasis and gastric ulcer. The patient had ever been treated with laparoscopic cholecystectomy in other hospital 5 days ago, but the postoperative patient appeared jaundice of skin and sclera, and the status of energy of patient was poor, the color of urine was shading yellow. The preoperative liver function of the patient was rough normal, however the volume of liver function include ALT, ALP, γ-GT, T-BIL and D-BIL gradually ascended. Moreover Intrahepatic bile ducts were found slight dilatation and the wall of bile duct was incrassated and the image of porta hepatic was broken with upper abdomen examination of MRI and MRCP, meanwhile about 2.0cmx 1.5cm size abnormal echo was found at porta hepatic by ultrasound, so the patient was delivered to the general surgery of our hospital. Physical examination found his vital sign is normal, skin and sclera stained yellow, about three long 0.5-1.2cm operative wound of laparoscopic cholecystectomy can be seen, which healed up. It was not found obviously abnormality in his heart, lungs and abdomen with physical examination. Later days the patient was recheck by ultrasound in our hospital, the size of abnormal echo was to achieve 3.8cm× 1.8cm in fossa of gallbladder. The liver function after laparoscopic cholecystectomy 6 days markedly ascended compare to 2 days ago. Urine routine showed urobilin was (2+). So the patient was delivered to operation room with exploratory laparotomy after hospitalization 3 days and diagnosed common hepatic duct transection hurt and chronic cholangitis. Then Roux-en-Y hepaticojejunostomy was used successfully to repair transaction hurt. The patient was rehabilitation discharge after postoperative 11 days. The patient was normal by postoperation fellow-up.