An option of conservative management of a duodenal injury following laparoscopic cholecystectomy

Abstract

Duodenal injury following laparoscopic cholecystectomy is rare complications with catastrophic sequelae. Most injuries are attributed to thermal burns with electrocautery following adhesiolysis and have a delayed presentation requiring surgical intervention. We present a case of a 47-year-old gentleman operated on for laparoscopic cholecystectomy with a bilious drain postoperatively; for which an ERC was done showing choledocholithiasis with cystic duct stump blow-out and a drain in the duodenum suggestive of an iatrogenic duodenal injury. He was managed conservatively like a duodenal fistula and recovered without undergoing any intervention.

Figure 1

CT scan showing the drain in the 2nd part of duodenum.

Figure 2

Postoperative ERCP showing a coiled drain in the duodenum.

Figure 3

Postoperative ERCP showing a mid-CBD calculi and cystic duct stump blow-out. A drain (ryles tube) is seen in the region of duodenum.

Figure 4

Tube conray gram showing the dye filling up in the duodenum without evidence of any intraperitoneal leak.

Figure 5

Duodenum at stent removal after removal of drain.