Injury to aberrant bile ducts during cholecystectomy: a common cause of diagnostic error and treatment delay.
OBJECTIVE: The purpose of this study was to determine the prevalence of injured aberrant bile ducts in a population with complications after cholecystectomy and to determine whether such injury resulted in significant delay in the diagnosis and treatment of bile duct injuries. MATERIALS AND METHODS: The cholangiograms of 82 patients who sustained bile duct injury during cholecystectomy were reviewed. Prevalence of aberrant bile duct anatomy in the injured ducts was noted. The time periods from injury to diagnosis and treatment of bile duct leaks in patients with aberrant bile duct anatomy were compared with those in patients with normal anatomy. RESULTS: Seventeen percent (14/82) of the patients were found to have aberrant bile duct anatomy. Fifteen percent (12/82) were found to have had an aberrant bile duct involved in the injury. Eleven of the patients had an aberrant bile duct leak, and one patient had an aberrant bile duct clipping injury. The time period required for diagnosis and treatment of a leaking aberrant bile duct was significantly longer (p < .005) than that required for a bile leak in an anatomically normal bile duct. CONCLUSION: Aberrant bile ducts are present in a significant number of patients who sustain bile duct injuries during cholecystectomy. Diagnosis of an aberrant bile duct leak may be delayed because of nonfilling of the bile duct during standard cholangiographic techniques. Careful examination of cholangiograms for nonfilling segments and contrast material injection of biloma drains and T tubes may shorten the time to definitive treatment for this group of patients.
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