Iatrogenic Hepatopancreaticobiliary Injuries: A Review

Abstract

Iatrogenic hepatopancreaticobiliary injuries occur after various types of surgical and nonsurgical procedures. Symptomatically, these injuries may lead to a variety of clinical presentations, including tachycardia and hypotension from hemobilia or hemorrhage. Iatrogenic injuries may be identified during the intervention, immediately afterwards, or have a delayed presentation. These injuries are categorized into nonvascular and vascular injuries. Nonvascular injuries include biliary injuries such as biliary leak or stricture, pancreatic injury, and the development of fluid collections such as abscesses. Vascular injuries include pseudoaneurysms, arteriovenous fistulas, dissection, and perforation. Imaging studies such as ultrasound, computed tomography, magnetic resonance imaging, and digital subtraction angiography are critical for proper diagnosis of these conditions. In this article, we describe the clinical and imaging presentations of these iatrogenic injuries and the armamentarium of minimally invasive procedures (percutaneous drainage catheter placement, balloon dilatation, stenting, and coil embolization) that are useful in their management.

Hemobilia after bile duct resection: perforation of pseudoaneurysm into intra-pancreatic remnant bile duct: a case report

“…First, hemobilia occurred due to perforation of the pseudoaneurysm derived from the GDA into the intra-pancreatic remnant bile duct after hepatectomy with BDR. Surgical intervention is known as one of the causes of hemobilia [ 1 , 2 ]. In most cases, an iatrogenic injury of the right hepatic or cystic artery can induce hemobilia because of the formation of a pseudoaneurysm and rupture to the common bile duct [ 1 , 2 ].…”

“…Hemobilia is defined as the extravasation of blood into the biliary tract. It is one of the morbidities related to hepato-biliary-pancreatic surgery, and ranges from minor to severe bleeding, which is life-threatening [ 1 , 2 ]. The main cause of hemobilia is iatrogenic, such as impairment of the right hepatic or cystic artery, and bile duct [ 2 ].…”

Hemobilia: Etiology, diagnosis, and treatment

“…27–30 Bile is known to cause endothelial damage to blood vessels, and iatrogenic injury that occurs to both the arterial and biliary structures can lead to delayed healing and the formation of pseudoaneurysms. 31 The majority of pseudoaneurysms occur in the right hepatic artery, though they can occur in any artery near the hepatobiliary system. 32,33…”

Percutaneous Management of Biliary Enteric Anastomotic Strictures: An Institutional Review

“…The laparoscopic surgical approach is overall safe with reduced recovery time and lower rate of complications than traditional open approach. However, there is reported incidence of 0.1 to 0.2% iatrogenic bile duct injuries (BDI) with open cholecystectomy which further increases to 0.4 to 0.6% with laparoscopic cholecystectomy [ 2 - 4 ]. Most of the repair procedures include biliary-enteric (BE) anastomoses which is technically challenging [ 5 ].…”