Injury to aberrant bile ducts during cholecystectomy: a common cause of diagnostic error and treatment delay.

TLDR

Aberrant bile duct leaks are often missed on standard cholangiograms because the ducts do not fill, delaying diagnosis. The study assessed the prevalence of injured aberrant bile ducts and their impact on diagnostic and treatment delays after cholecystectomy. The authors reviewed 82 cholangiograms, identified aberrant anatomy, compared time to diagnosis and treatment between aberrant and normal ducts, and recommended meticulous imaging and contrast injection to reduce delays. Seventeen percent of patients had aberrant bile ducts, 15% of injuries involved them, and leaks from aberrant ducts required significantly longer time to diagnose and treat compared to normal ducts.

Abstract

The purpose of this study was to determine the prevalence of injured aberrant bile ducts in a population with complications after cholecystectomy and to determine whether such injury resulted in significant delay in the diagnosis and treatment of bile duct injuries.The cholangiograms of 82 patients who sustained bile duct injury during cholecystectomy were reviewed. Prevalence of aberrant bile duct anatomy in the injured ducts was noted. The time periods from injury to diagnosis and treatment of bile duct leaks in patients with aberrant bile duct anatomy were compared with those in patients with normal anatomy.Seventeen percent (14/82) of the patients were found to have aberrant bile duct anatomy. Fifteen percent (12/82) were found to have had an aberrant bile duct involved in the injury. Eleven of the patients had an aberrant bile duct leak, and one patient had an aberrant bile duct clipping injury. The time period required for diagnosis and treatment of a leaking aberrant bile duct was significantly longer (p < .005) than that required for a bile leak in an anatomically normal bile duct.Aberrant bile ducts are present in a significant number of patients who sustain bile duct injuries during cholecystectomy. Diagnosis of an aberrant bile duct leak may be delayed because of nonfilling of the bile duct during standard cholangiographic techniques. Careful examination of cholangiograms for nonfilling segments and contrast material injection of biloma drains and T tubes may shorten the time to definitive treatment for this group of patients.