Article Text

Download PDFPDF
Bile duct injury: to err is human; to refer is divine
  1. Saket Kumar,
  2. Pavan Kumar and
  3. Abhijit Chandra
  1. King George’s Medical University, Surgical Gastroenterology, Lucknow, Uttar Pradesh, India
  1. Correspondence to Dr Saket Kumar, krsaketsingh{at}


A 42-year-old woman sustained complete transection of common hepatic duct during routine laparoscopic cholecystectomy. The surgery was being performed at a rural setting, and the injury was identified intraoperatively. The surgeon sought the opinion of an expert biliary surgeon via telephone and discussed the possibility of an immediate end-to-end bile duct repair. Since he lacked the experience of doing biliary-enteric anastomosis, he was advised to place a subhepatic drain and transfer the patient to the hepatobiliary centre for definitive surgery. At the referral centre, the patient was evaluated and planned an immediate biliary repair. On exploration, she was found to have a major type, Strasberg E5 injury. The transected ducts were small in calibre and required double Roux-en-Y hepaticojejunostomy over transanastomotic stents. The postoperative recovery was uneventful. Transanastomotic stents were removed after 6 months, and the patient remained perfectly well at a follow-up of 1 year.

  • biliary intervention
  • gastrointestinal surgery
  • emergency medicine
View Full Text

Statistics from


  • Contributors SK, PK and AC: concept and design, drafting of the manuscript and critical revision. SK and PK: performed the repair surgery and collected the radiological reports. The manuscript has been read and approved by all the authors, the requirements for authorship as stated earlier in this document have been met, and each author believes that the manuscript represents honest work if that information is not provided in another form.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.