Bile Duct Injury during Cholecystectomy Requiring Delayed Liver Transplantation: A Case Report and Literature Review

  • Öncel Didem
    Department of General Surgery (Hepatopancreatobiliary Surgery Unit), Istanbul University, Istanbul Faculty of Medicine
  • Özden Ilgin
    Department of General Surgery (Hepatopancreatobiliary Surgery Unit), Istanbul University, Istanbul Faculty of Medicine
  • Bilge Orhan
    Department of General Surgery (Hepatopancreatobiliary Surgery Unit), Istanbul University, Istanbul Faculty of Medicine
  • Tekant Yaman
    Department of General Surgery (Hepatopancreatobiliary Surgery Unit), Istanbul University, Istanbul Faculty of Medicine
  • Acarli Koray
    Department of General Surgery (Hepatopancreatobiliary Surgery Unit), Istanbul University, Istanbul Faculty of Medicine
  • Alper Aydin
    Department of General Surgery (Hepatopancreatobiliary Surgery Unit), Istanbul University, Istanbul Faculty of Medicine
  • Emre Ali
    Department of General Surgery (Hepatopancreatobiliary Surgery Unit), Istanbul University, Istanbul Faculty of Medicine
  • Ariogul Orhan
    Department of General Surgery (Hepatopancreatobiliary Surgery Unit), Istanbul University, Istanbul Faculty of Medicine

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Abstract

Major bile duct injury during cholecystectomy represents potentially severe complications with unpredictable long-term results. If these lesions are not treated adequately, they can lead to hepatic failure or secondary biliary cirrhosis therefore requiring liver transplantation. We report a patient who required liver transplantation 15 years after open cholecystectomy. A l0-year old girl underwent open cholecystectomy and duodenal repair for cholelithiasis and cholecystoduodenal fistula. She required two surgical inteventions, hepaticojejunostomy which was performed in another center and portoenterostomy for biliary stricture at our institution seven years after the cholecystectomy. Eight years after the third operation, she required recurrent hospitalization for treatment of hepatic abscesses. The extremely short intervals between the three life threatening episodes and the rapid progression to severe sepsis were taken into consideration and liver transplantation was performed at the age of 25. She is leading a healthy life at 4 years post transplantation. Although iatrogenic biliary injury can usually be treated successfully by a combination of surgery, radiological and endoscopic techniques, patients with severe injuries develop irreversible liver disease. This case report and review of the literature suggest that liver transplantation is a treatment modality for a selected group of patients with end-stage liver disease secondary to bile duct injury.

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