Aberrant right hepatic ducts are the most common biliary tract anomaly and are particularly susceptible to injury at cholecystectomy because of their critical location. The authors report radiologic diagnosis and therapy in five cases of inadvertent ligation of this duct at cholecystectomy. The diagnosis was unsuspected prior to the radiologic studies in each patient. Four patients experienced recurrent cholangitis; one patient had chronic pain as the only symptom. Prior to diagnosis, the duration of symptoms ranged from 2 weeks to 126 months. Findings at ultrasound, computed tomography, and percutaneous transhepatic cholangiography with differential biliary pressures helped establish the diagnosis in each patient. Findings at endoscopic retrograde cholangiopancreatography were nondiagnostic in four patients. Percutaneous biliary drainage provided palliation of symptoms, improved each patient's condition prior to reconstructive surgery, and provided an intraoperative landmark for the surgeon. Two patients had associated bilomas, one of which was infected and was drained percutaneously. All patients survived and recovered without further complications.
This report summarizes diagnostic and therapeutic radiologic procedures inThe operation generally is well tolerated, particularly in young and middle-aged patients. Morbidity is reported to be from 4% to 32% in several large surgical series,'. 3-8 whereas mortality rates vary from 0.4% to 2.5%.1-6, The most frequent complications of chole-
11/56/18794cystectomy are wound infection, abscess formation, ductal injury or ligation, and bleeding.3, "-") Elderly patients undergoing emergency cholecystectomy are more prone to complications and serious sequelae; their mortality rate is approximately double that of young During the past 4 years, we have performed interventional radiologic procedures in 45 patients to diagnose and treat serious complications of cholecystectomy. This report describes the spectrum of these procedures and the benefits of interventional radiology for the surgeon in the treatment of these patients.
MATERIAL AND METHODSThe 45 patients who underwent cholecystectomy include 34 women and 1 1 men whose ages range from 19 to 82 years. Complications were appreciated at the time
SURGERY
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The authors describe their experience in management of bile duct injuries (n = 11), bile leaks or abscesses (n = 11), and bleeding (n = 1) as complications of laparoscopic cholecystectomy in 21 patients. Clinical presentations included jaundice, sepsis, pain, abdominal distention, and persistent gallstones. Twelve patients underwent operative cholangiography, three underwent conversion to open cholecystectomy, and 12 reoperations were performed in nine patients before interventional radiologic procedures, which included diagnostic percutaneous transhepatic cholangiography (n = 13), percutaneous biliary drainage (PBD) (n = 13), percutaneous stricture dilation (n = 3), stent insertion (n = 1), percutaneous abscess or biloma drainage (n = 19), and gallstone removal (n = 1). Each procedure was technically successful. Clinical improvement occurred in 18 of 19 patients. PBD was used as an operative guide before reconstructive surgery in two patients. Reoperation was unnecessary in 10 of 21 patients (48%). One patient died of fungal sepsis and pulmonary complications. This radiologic-surgical approach provided rapid and safe management of these complications.
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