Bile duct injury and repair (Draft) [Case 28]

Imaging Analysis

Look through the patient's CT scan to identify any areas of concern for the necessary procedure.

Initial CT scan

Axial 1

Axial 2

Axial 3

Axial 4

Axial 5

Axial 6

Axial 7

Imaging analysis

CT Scan Referral Report on admission to HPB centre

On Post-Operative Day 12, abdominal lavage and drainage was done. Multiple abdominal abscesses were found. Bile culture was positive for E. faecium. The patient was started on antibiotic therapy.

After gradual improvement of clinical condition and decrease in bile leak output, the patient was discharged on Post-Operative Day 5 and sent home with a sub-hepatic abdominal drain. The patient was followed on an outpatient setting with progressive withdrawing of the abdominal drain towards obtaining a complete closure of the fistula.

On follow up MRI, a stricture was seen suggesting a Bismuth Type 3 injury. The main bile duct confluence is preserved.

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Acknowledgements
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