BILIODIGESTIVE BYPASS AFTER BISMUTH TYPE III INJURY

• DOI: 10.22533/at.ed.15925022290810

• Palavras-chave: benign stenosis; bile ducts; Bismuth type III

• Keywords: benign stenosis; bile ducts; Bismuth type III

• Abstract:

  Benign bile duct stenosis is mainly caused by intraoperative injury or, later, by scarring bile duct stenosis. Anatomical variations or distortions of the extrahepatic bile ducts, acute or chronic inflammation make it difficult to visualize the cystic-choledochal junction, increasing the risk of accidents, even with experienced surgeons. The report was of a patient with pain in the right hypochondrium, jaundice, pruritus and choluria, which appeared two days after open cholecystectomy. Prior to cholecystectomy, the patient reported biliary colic, with no history of cholestasis; she had undergone an abdominal ultrasound whose gallbladder had evidenced a stone measuring 2.6 cm, and the surgery was performed at another service; after the onset of jaundice, she underwent magnetic resonance cholangiography, demonstrating dilation of the intrahepatic bile ducts and abrupt narrowing of the lumen in the topography of the proximal common hepatic duct, and normal-caliber common bile duct. Surgery was indicated for reconstruction of the bile ducts (45 days after cholecystectomy), performing a biliodigestive bypass through hepatojejunostomy in Y of Roux. The patient was clinically stable, with no abdominal pain, nausea and vomiting, and was discharged after 11 days. Thus, it can be seen that the surgical lesion is the main cause of benign bile duct stenosis (95%). In order to avoid such a complication, the surgeons' experience and meticulous technique are of great importance. Successful management of these lesions requires the surgeon's experience with hepatobiliopancreatic pathologies, seeking a definitive resolution in these situations.

• Número de páginas: 6