Biliary peritonitis due to laparoscopic bile duct injury

Case contributed by Dr Ammar Haouimi

Presentation

Had laparoscopic cholecystectomy 5 days prior for gallstones.

Patient Data

Age: 50 years
Gender: Female

Moderate amount of abdominal free fluid mainly around the liver, spleen, gallbladder fossa, and in the paracolic gutters with free intraperitoneal gas (postoperative). Thickening with an enhancement of the peritoneal reflections.

The MRCP (source images and 3D) shows a small connection between the fluid collection in the gallbladder fossa and the common hepatic duct just above the cystic duct remnant and 1.7 cm from the biliary confluence.

A short stricture with well-defined margins is seen at the upper portion of the common hepatic duct with no dilatation of the intrahepatic biliary tree in keeping with a pseudostricture or pseudonarrowing due to a vascular impression.

Annotated images:

  • black arrow: cyst duct remnent
  • white arrow: fluid collection in gallbladder fossa
  • green arrow: connection between the collection in gallbladder fossa and CHD

Case Discussion

MRI features of biliary peritonitis due to iatrogenic bile duct injury following laparoscopic cholecystectomy (type E2 according to Strasberg classification of bile duct injury ) that was confirmed at surgery.

Bile duct injuries may occur after gallbladdergastric or pancreas surgery, more frequent with laparoscopic cholecystectomy as in this case.

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