Biliary Duct Injury Induced by Surgery for Mirizzi Syndrome with Follow-up for 16 Years: a Report and Literature Review

XIAO Qing-chuan; HU Hong-qiang; QIN Hong-jun; SHI Ji-qing; LI Jia-jun

doi:10.3969/j.issn.1002-3429.2017.04.006

Abstract：Objective To investigate treatment strategies and preventive measures of complex iatrogenic bile duct injury.Methods Process of clinical diagnosis and treatment for a Mirizzi syndrome patient with bile duct injury induced by surgery, who was followed for 186 months, was retrospective analyzed, and related literature was reviewed.Pathogenesy reasons, prosthodontic treatment timing and methods and the criteria of judging curative effect were analyzed.Results The patient underwent open cholecystectomy for gallstone accompanied with chronic atrophic cholecystitis, and Mirizzi syndrome (type I) was confirmed during surgery.Definitive reconstructive surgery was implemented because of serious adhesion and bile were found in the operative visual fields, and bile duct transection was found at 0.5 cm below the junction point of the left and right hepatic ducts after careful observation, and the surgery achieved good effect with 5 years of follow-up.Biliary stricture was observed in postoperative 6th year, and then following excision of diseased bile duct, reconstruction of bile duct and choledochojejunostomy were conducted.Anastomotic stricture and left liver atrophy were found in 3 years later, and then removal of biliary-intestinal anastomosis, excision of left liver, reconstruction of the right hepatic duct and second choledochojejunostomy were conducted.No obviously uncomfortable symptoms were found during followed up for 3 years.Conclusion The main causes of iatrogenic bile duct injury are the carelessness of surgical physicians and the complexity of patients' pathological changes.It's suggested that definitive surgeries should be implemented positively by experienced specialists after considering generally physical conditions and the well local circumstance of the diseased bile duct of patients, and follow-up visit time should be at least 20 years.