Perseverance pays: A complicated case of post laparoscopic cholecystectomy duodenal injury

Jakhmola, C.K.; Kumar, Ameet; Arora, Niyati; Chauhan, Smita; Kukreja, Yogesh

doi:10.1016/j.mjafi.2015.01.016

Cited by 2 publications

(3 citation statements)

References 9 publications

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“… 8 , 23 , 28 Intraoperative identification of the injury involved leakage of intestinal material in some portion of the duodenum after dissection of adhesions to the duodenum. 18 , 29 , 30 When the injury is detected postoperatively, it can present as fluid, collections, periduodenal abscesses, or drainage leaks. 29 , 31 However, identifying postoperative injuries is more challenging due to the inflammatory response generally secondary to emergency cholecystectomies.…”

Section: Discussionmentioning

confidence: 99%

“… 9 , 18 , 27 , 36 , 37 Appropriate surgical treatment must be timely and prompt, and the faster the surgical management is, the better the prognosis. 8 , 30 Once surgical revision has been performed, it is important to evaluate the extent of the injury to the duodenal portion. The Kocher maneuver helps to identify the margins of the lesion and relieves the tension associated with injury closure.…”

Section: Discussionmentioning

confidence: 99%

“…For these reasons, detection time is very important in the prognosis of these fearsome injuries. 18 , 27 , 30 The majority of these injuries are small and can be repaired via primary closure if they are detected intraoperatively or within the first few hours. In the minority, these injuries require more complex management.…”

Section: Discussionmentioning

confidence: 99%

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Postcholecystectomy Duodenal Injuries, Their Management, and Review of the Literature

Diaz-Martinez,

Pérez-Correa

2024

Euroasian Journal of Hepato-Gastroenterology

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A bstract Backgrounds Laparoscopic cholecystectomy (LC) is the gold standard for treating gallstones; however, it is not free of complications. Postcholecystectomy duodenal injuries are rare but challenging complications after cholecystectomy. The objective of this study was to analyze the management of postcholecystectomy duodenal injuries and to review the related literature. Materials and methods An observational and retrospective study was conducted. We included all patients with postcholecystectomy duodenal injuries treated at a reference center, from January 2019 to December 2023. In addition, a review of the literature was carried out. Results Fifteen patients were found, mostly women; with gallbladder wall thickening on ultrasound (mean of 8 mm). The majority were emergency ( n = 12, 80%) and LCs ( n = 8, 53.33%). Cholecystectomies were reported to be associated with excessive difficulty ( n = 10, 66.66%). The most injured duodenal portion was the first portion ( n = 9, 60%), and blunt dissection was the most common mechanism of injury ( n = 7, 46.66%). Most of these injuries were detected in the operating room ( n = 9, 60%), and treated with primary closure ( n = 11, 73.33%). Three patients with delayed injuries died (20%). According to the literature reviewed, 93 duodenal injuries were found, mostly detected intraoperatively, in the second portion, and treated with primary closure. A minority of patients were treated with more complex procedures, for a mortality rate of 15.38%. Conclusion Postcholecystectomy duodenal injuries are rare. Most of these injuries are detected and repaired intraoperatively. However, a high percentage of patients have high morbidity and mortality. How to cite this article Diaz-Martinez J, Pérez-Correa N. Postcholecystectomy Duodenal Injuries, Their Management, and Review of the Literature. Euroasian J Hepato-Gastroenterol 2024;14(1):44–50.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Postcholecystectomy Duodenal Injuries, Their Management, and Review of the Literature

Diaz-Martinez,

Pérez-Correa

2024

Euroasian Journal of Hepato-Gastroenterology

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Iatrogenic Duodenal Perforation After Surgery: a Systematic Review

et al. 2023

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Duodenal perforation consequent to prior surgery is a rare but severe complication carrying serious consequences if not promptly managed. This study aims to identify the best treatment pathway available to date. This is a systematic review registered to PROSPERO. The literature research was conducted on Ovid Medline, Embase, and Cochrane up to February 2022 to identify all papers reporting surgical-related duodenal perforations. Twelve articles were included. Most of these studies were case reports or case series. The most common cause of perforation was laparoscopic cholecystectomy (72.7%). The median time to symptom appearance was 2 days. Most of these perforations were severe injuries located in the first portion of the duodenum. Only one patient was treated with a non-interventional conservative management, which failed. Five patients were managed with interventional non-surgical treatments: 4 with endoscopy (50% failure) and one with a percutaneous occluder. Different surgical treatments were reported: direct suture (100% failure), direct suture and T-tube duodenostomy (75% failure), simple abdominal drainage, and suture with pyloric exclusion. Further extensive surgeries were also reported. The overall mortality rate was 13.6%, with a median hospital stay of 38.5 days. This review shows a wide spectrum of managements for patients with duodenal perforation related to prior surgery. The decision on which treatment to adopt must consider patient’s clinical setting and duodenal defect characteristics (size, site, and time to diagnosis). A tentative treatment flowchart is provided, although larger sample size studies are needed to obtain a treatment pathway based on evidence.

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Perseverance pays: A complicated case of post laparoscopic cholecystectomy duodenal injury

Cited by 2 publications

References 9 publications

Postcholecystectomy Duodenal Injuries, Their Management, and Review of the Literature

Postcholecystectomy Duodenal Injuries, Their Management, and Review of the Literature

Iatrogenic Duodenal Perforation After Surgery: a Systematic Review

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