University of California San Francisco

Bile Duct Injuries

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The late clinical course of bile duct injury leads to chronic liver disease, cirrhosis and portal hypertension, with liver transplantation the last hope of cure.

Bile duct injuries (BDI) take place in a wide spectrum of clinical settings. The mechanisms of injury, previous attempts of repair, surgical risk and general health status importantly influence the diagnostic and therapeutic decision-making pathway of every single case. A multidisciplinary approach including internal medicine, surgery, endoscopy and interventional radiology specialists is required to properly manage this complex disease. BDI may occur after gallbladder, pancreas and gastric surgery, with laparoscopic cholecystectomy responsible for 80%-85% of them

http://my.clevelandclinic.org/services/digestive_diseases/diseases-conditions/hic-bile-duct-injuries-during-gall-bladder-surgery

Benign strictures develop when the bile ducts are injured in some way. The injury may be a single acute event, such as damage to the bile ducts during surgery or trauma to the abdomen; a recurring condition, such as pancreatitis or bile duct stones; or a chronic disease, such as primary sclerosing cholangitis (PSC).


What is a bile duct stricture?

A bile duct stricture is caused by narrowing of the bile duct. The narrow bile duct prevents the bile from draining into the intestine. The bile then backs up in the liver and spills over into the blood causing obstructive jaundice?

What are the causes of bile duct stricture?

There are many causes for biliary stricture. These causes can be benign (non-cancerous) or cancerous. Cancerous bile duct strictures are caused by bile duct cancer and pancreatic cancer. Benign (non-cancerous) bile duct strictures may develop from chronic pancreatitis, injury to the bile duct after a laparoscopic cholecystectomy and a variety of infective causes that are uncommon in the United States.

The most common cause for a benign bile duct stricture is trauma to the bile duct during a laparoscopic cholecystectomy for gallstone disease. It is estimated that approximately 0.1% to 1% of gallbladder operations may lead to injury to the bile duct with subsequent development of a bile duct stricture. In addition to injury to the bile duct, injury to the hepatic artery (the blood vessel that supplies blood to the liver) is commonly associated with a bile duct injury.

Biliary stricture

    

A biliary stricture is an abnormal narrowing of the common bile duct, the tube that moves bile from the liver to the small intestine. Bile is a substance that helps with digestion.

Causes

A biliary stricture is often caused by injury to the bile ducts during surgery. For example, it may occur after surgery to remove the gallbladder.

Other causes of this condition include:

Risk factors include: 

  • Gallstones
  • Injury to the intestines
  • Pancreatitis
  • Previous biliary surgery

Symptoms


Exams and Tests

The following tests can help diagnose this condition:

The following blood tests can help reveal a problem with the biliary system.

This condition may also alter the results of the following tests:

Treatment

The goal of treatment is to correct the narrowing so bile can flow from the liver into the intestine.

This may involve:

  • Surgery
  • Endoscopic or percutaneous dilation 

If surgery is done, the stricture is removed. The common bile duct will be rejoined with the small intestine.

In some cases, a tiny metal or plastic mesh tube (stent) is placed across the bile duct stricture to keep it open. 

Outlook (Prognosis)

Treatment is successful most of the time.

Possible Complications

Inflammation and narrowing of the biliary duct may return in some people. There is a risk for infection above the narrowed area. Strictures that remain for a long period can lead to liver damage (cirrhosis).