الفهرس يوجد فقط 14 صفحة متاحة للعرض العام
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المستخلص
In this study, 30 patients with post cholecystectomy bile duct
injuries were assessed, 19.of which were females and 11 males. The ages
of the patients ranged between 30 and 65 years. 5 patients were diagnosed
intra - operatively while 25 patients were diagnosed in the post operative
period.
The time of presentation of patients diagnosed postoperatively
varied significantly among the patients ranging from a few days to 13
months. 17 patients presented clinically with obstructive jaundice with or
without cholangitis. 2 patients presented with biliary peritonitis while 4
patients presented with external biliary fistulae and 2 R€l~jents presented
with an intra abdominal collection (biloma)
All the patients were assessed through a thorough history taking
and physical examination, in addition to complete laboratory work - up.
Abdominal ultrasound was done as a routine primary investigation for all
patients. It was very accurate in the detection of intrahepatic biliary
dilatation and intraperitoneal collections and their aspiration
ERCP was successfully performed as a preoperative investigative
tool in 15~atients with accurate results documenting the level of bile duct
injuries, failure in one case, also it was successful in management of 9
cases.
PTC was a successful preoperative diagnostic tool in two patients,
clearly delineating the proximal biliary tree and identifying the level of
injury. PTC with external drainage of the biliary tree (PTD) was avoided
to keep the advantage of finding dilated bile ducts in subsequent planned
surgery shortly afterwards.
MRCP was done as a preoperative diagnostic tool for 8 patients it
showed excellent results in accurately specifying the level of the injury,
and the degree of dilatation of the proximal biliary tree.
Management depended largely on time of diagnosis. Spatients
(those diagnosed intraoperatively) were managed immediately. 11
patients were managed by non - surgical treatment through ERCP or US
I
guided drainage. 14 patients were managed by surgery, 2 patients
managed by surgical drainage and 12 patients managed by bilioenteric
anastomosis.