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Gulhane Med J. 2002; 44(4): 415-422


Endoscopic Diagnosis and Treatment in Patients With Bile Duct Injury Due to Cholecystectomy

Dr. Sait BAĞCI1, Dr. Cemal Nuri ERÇİN1, Dr. Ahmet TÜZÜN1, Dr. Mustafa GÜLŞEN1, Dr. Ahmet UYGUN1, Dr. Müjdat BALKAN2, Dr. Nihat KAYMAKÇIOĞLU2, Dr. Ali İhsan UZAR2, Dr. Necmettin KARAEREN1, Dr. Kemal DAĞALP1.

Abstract
Injury to the bile duct is a serious complication of cholecystectomy and bile tract surgery. The manage ment of these cases is conventionally open laparato my with direct repair. In this study we evaluate the diagnostic and therapeutic ERCP findings with bile duct injury after cholecystectomy in our patients. 28 patients (25 women, 3 men, mean age 43.7) with suspicion of bile duct injury were referred to our clinic for ERCP. Bile ducts of the patients were visualized and found the localization of the injury by ERCP except one (%96.4). Cholangiogram was normal in 1 patient. 8 bile duct transections, 3 severe strictures located in choledochus or bifurcation, 3 bile leaks from choledochus were acutely recognized and treated with surgery. 3 patients with fistula of choledochus or cystic duct stump were treated with sphincterotomy( ST) and nasobiliary drainage (NBD). 5 patients with bile duct stricture, bile leak+stricture, bile duct obstruction+leak, choledocholithiasis+stricture or choledocholithiasis were treated with ST, NBD and removal of the stone with ERCP. Stent was endoscopically applied for a long period in 3 patients. In all, 11(%42.3) of 26 patients with pathological findings were treated by only ERCP procedures. Complications after ERCP were minimal, consisting of three cases of mild, self-limited pancreatitis (% 11.1). In conclusion, ERCP is a safe and effective method for diagnose and treatment in patients with bile duct injury and should be considered always before surgery or percutaneous procedure.

Key words: ERCP, Bile Duct Injury



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