Iatrogenic Hepatopancreaticobiliary Injuries: A Review

Abstract

Iatrogenic hepatopancreaticobiliary injuries occur after various types of surgical and nonsurgical procedures. Symptomatically, these injuries may lead to a variety of clinical presentations, including tachycardia and hypotension from hemobilia or hemorrhage. Iatrogenic injuries may be identified during the intervention, immediately afterwards, or have a delayed presentation. These injuries are categorized into nonvascular and vascular injuries. Nonvascular injuries include biliary injuries such as biliary leak or stricture, pancreatic injury, and the development of fluid collections such as abscesses. Vascular injuries include pseudoaneurysms, arteriovenous fistulas, dissection, and perforation. Imaging studies such as ultrasound, computed tomography, magnetic resonance imaging, and digital subtraction angiography are critical for proper diagnosis of these conditions. In this article, we describe the clinical and imaging presentations of these iatrogenic injuries and the armamentarium of minimally invasive procedures (percutaneous drainage catheter placement, balloon dilatation, stenting, and coil embolization) that are useful in their management.

Keywords

hepatobiliary - hepatopancreaticobiliary - bile duct injury - iatrogenic injuries - interventional radiology

• References

• 1 Lau WY, Lai EC, Lau SH. Management of bile duct injury after laparoscopic cholecystectomy: a review. ANZ J Surg 2010; 80 (1–2) 75-81
• 2 Nuzzo G, Giuliante F, Giovannini I , et al. Advantages of multidisciplinary management of bile duct injuries occurring during cholecystectomy. Am J Surg 2008; 195 (6) 763-769
• 3 Flum DR, Cheadle A, Prela C, Dellinger EP, Chan L. Bile duct injury during cholecystectomy and survival in Medicare beneficiaries. JAMA 2003; 290 (16) 2168-2173
• 4 Saad N, Darcy M. Iatrogenic bile duct injury during laparoscopic cholecystectomy. Tech Vasc Interv Radiol 2008; 11 (2) 102-110
• 5 Roslyn JJ, Binns GS, Hughes EF, Saunders-Kirkwood K, Zinner MJ, Cates JA. Open cholecystectomy. A contemporary analysis of 42,474 patients. Ann Surg 1993; 218 (2) 129-137
• 6 MacFadyen Jr BV, Vecchio R, Ricardo AE, Mathis CR. Bile duct injury after laparoscopic cholecystectomy. The United States experience. Surg Endosc 1998; 12 (4) 315-321
• 7 McPartland KJ, Pomposelli JJ. Iatrogenic biliary injuries: classification, identification, and management. Surg Clin North Am 2008; 88 (6) 1329-1343 , ix
• 8 Waage A, Nilsson M. Iatrogenic bile duct injury: a population-based study of 152 776 cholecystectomies in the Swedish Inpatient Registry. Arch Surg 2006; 141 (12) 1207-1213
• 9 Jabłońska B, Lampe P. Iatrogenic bile duct injuries: etiology, diagnosis and management. World J Gastroenterol 2009; 15 (33) 4097-4104
• 10 Lee AY, Gregorius J, Kerlan Jr RK, Gordon RL, Fidelman N. Percutaneous transhepatic balloon dilation of biliary-enteric anastomotic strictures after surgical repair of iatrogenic bile duct injuries. PLoS ONE 2012; 7 (10) e46478
• 11 Caiado AHM, Blasbalg R, Marcelino AS , et al. Complications of liver transplantation: multimodality imaging approach. Radiographics 2007; 27 (5) 1401-1417
• 12 Lillemoe KD, Melton GB, Cameron JL , et al. Postoperative bile duct strictures: management and outcome in the 1990s. Ann Surg 2000; 232 (3) 430-441
• 13 Thompson CM, Saad NE, Quazi RR, Darcy MD, Picus DD, Menias CO. Management of iatrogenic bile duct injuries: role of the interventional radiologist. Radiographics 2013; 33 (1) 117-134
• 14 Törnqvist B, Strömberg C, Persson G, Nilsson M. Effect of intended intraoperative cholangiography and early detection of bile duct injury on survival after cholecystectomy: population based cohort study. BMJ 2012; 345: e6457
• 15 Aduna M, Larena JA, Martín D, Martínez-Guereñu B, Aguirre I, Astigarraga E. Bile duct leaks after laparoscopic cholecystectomy: value of contrast-enhanced MRCP. Abdom Imaging 2005; 30 (4) 480-487
• 16 Fulcher AS, Turner MA. Orthotopic liver transplantation: evaluation with MR cholangiography. Radiology 1999; 211 (3) 715-722
• 17 Chaudhary A, Negi SS, Puri SK, Narang P. Comparison of magnetic resonance cholangiography and percutaneous transhepatic cholangiography in the evaluation of bile duct strictures after cholecystectomy. Br J Surg 2002; 89 (4) 433-436
• 18 Kamaoui I, Milot L, Durieux M, Ficarelli S, Mennesson N, Pilleul F. [Value of MRCP with Mangafodipir Trisodium (Teslascan) injection in the diagnosis and management of bile leaks]. J Radiol 2007; 88 (12) 1881-1886
• 19 Saad WE, Wallace MJ, Wojak JC, Kundu S, Cardella JF. Quality improvement guidelines for percutaneous transhepatic cholangiography, biliary drainage, and percutaneous cholecystostomy. J Vasc Interv Radiol 2010; 21 (6) 789-795
• 20 Lau WY, Lai EC. Classification of iatrogenic bile duct injury. Hepatobiliary Pancreat Dis Int 2007; 6 (5) 459-463
• 21 Bismuth H, Majno PE. Biliary strictures: classification based on the principles of surgical treatment. World J Surg 2001; 25 (10) 1241-1244
• 22 Strasberg SM, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 1995; 180 (1) 101-125
• 23 Walsh RM, Henderson JM, Vogt DP, Brown N. Long-term outcome of biliary reconstruction for bile duct injuries from laparoscopic cholecystectomies. Surgery 2007; 142 (4) 450-456 , discussion 456–457
• 24 Misra S, Melton GB, Geschwind JF, Venbrux AC, Cameron JL, Lillemoe KD. Percutaneous management of bile duct strictures and injuries associated with laparoscopic cholecystectomy: a decade of experience. J Am Coll Surg 2004; 198 (2) 218-226
• 25 Fazel A. Postoperative pancreatic leaks and fistulae: the role of the endoscopist. Tech Gastrointest Endosc 2006; 8 (2) 92-98
• 26 Sanjay P, Kellner M, Tait IS. The role of interventional radiology in the management of surgical complications after pancreatoduodenectomy. HPB (Oxford) 2012; 14 (12) 812-817
• 27 Standop J, Glowka T, Schmitz V , et al. Operative re-intervention following pancreatic head resection: indications and outcome. J Gastrointest Surg 2009; 13 (8) 1503-1509
• 28 Veillette G, Dominguez I, Ferrone C , et al. Implications and management of pancreatic fistulas following pancreaticoduodenectomy: the Massachusetts General Hospital experience. Arch Surg 2008; 143 (5) 476-481
• 29 Gillams AR, Kurzawinski T, Lees WR. Diagnosis of duct disruption and assessment of pancreatic leak with dynamic secretin-stimulated MR cholangiopancreatography. AJR Am J Roentgenol 2006; 186 (2) 499-506
• 30 Gervais DA, Brown SD, Connolly SA, Brec SL, Harisinghani MG, Mueller PR. Percutaneous imaging-guided abdominal and pelvic abscess drainage in children. Radiographics 2004; 24 (3) 737-754
• 31 Beart Jr RW, Putnam CW, Starzl TE. Use of a U tube in the treatment of biliary disease. Surg Gynecol Obstet 1976; 142 (6) 912-914
• 32 Hui TT, Giurgiu DI, Margulies DR, Takagi S, Iida A, Phillips EH. Iatrogenic gallbladder perforation during laparoscopic cholecystectomy: etiology and sequelae. Am Surg 1999; 65 (10) 944-948
• 33 Zubair M, Habib L, Mirza MR, Channa MA, Yousuf M. Iatrogenic gall bladder perforations in laparoscopic cholecystectomy: an audit of 200 cases. Mymensingh Med J 2010; 19 (3) 422-426
• 34 Morrin MM, Kruskal JB, Hochman MG, Saldinger PF, Kane RA. Radiologic features of complications arising from dropped gallstones in laparoscopic cholecystectomy patients. AJR Am J Roentgenol 2000; 174 (5) 1441-1445
• 35 Malagari K, Pomoni M, Spyridopoulos TN , et al. Safety profile of sequential transcatheter chemoembolization with DC Bead™: results of 237 hepatocellular carcinoma (HCC) patients. Cardiovasc Intervent Radiol 2011; 34 (4) 774-785
• 36 Sakamoto I, Aso N, Nagaoki K , et al. Complications associated with transcatheter arterial embolization for hepatic tumors. Radiographics 1998; 18 (3) 605-619
• 37 Shah RP, Brown KT. Hepatic arterial embolization complicated by acute cholecystitis. Semin Intervent Radiol 2011; 28 (2) 252-257
• 38 Wagnetz U, Jaskolka J, Yang P, Jhaveri KS. Acute ischemic cholecystitis after transarterial chemoembolization of hepatocellular carcinoma: incidence and clinical outcome. J Comput Assist Tomogr 2010; 34 (3) 348-353
• 39 Sag AA, Savin MA, Lal NR, Mehta RR. Yttrium-90 radioembolization of malignant tumors of the liver: gallbladder effects. AJR Am J Roentgenol 2014; 202 (5) 1130-1135
• 40 Thurley PD, Dhingsa R. Laparoscopic cholecystectomy: postoperative imaging. AJR Am J Roentgenol 2008; 191 (3) 794-801
• 41 Fernandes DD, Shyn PB, Silverman SG. Gallbladder needle decompression during radiofrequency ablation of an adjacent liver tumour. Can Assoc Radiol J 2012; 63 (3, Suppl): S37-S40
• 42 Han Y, Hao YZ, Cai JQ , et al. [Ultrasound-guided assistant infusion technique for percutaneous radiofrequency ablation of liver cancer]. Zhonghua Gan Zang Bing Za Zhi 2012; 20 (4) 266-269
• 43 Yamakado K, Nakatsuka A, Tanaka N, Takano K, Matsumura K, Takeda K. Transcatheter arterial embolization of ruptured pseudoaneurysms with coils and n-butyl cyanoacrylate. J Vasc Interv Radiol 2000; 11 (1) 66-72
• 44 Saad NE, Saad WE, Davies MG, Waldman DL, Fultz PJ, Rubens DJ. Pseudoaneurysms and the role of minimally invasive techniques in their management. Radiographics 2005; 25 (Suppl. 01) S173-S189
• 45 Tessier DJ, Fowl RJ, Stone WM , et al. Iatrogenic hepatic artery pseudoaneurysms: an uncommon complication after hepatic, biliary, and pancreatic procedures. Ann Vasc Surg 2003; 17 (6) 663-669
• 46 Madanur MA, Battula N, Sethi H, Deshpande R, Heaton N, Rela M. Pseudoaneurysm following laparoscopic cholecystectomy. Hepatobiliary Pancreat Dis Int 2007; 6 (3) 294-298
• 47 Watanabe M, Shiozawa K, Mimura T , et al. Hepatic artery pseudoaneurysm after endoscopic biliary stenting for bile duct cancer. World J Radiol 2012; 4 (3) 115-120
• 48 Paci E, Antico E, Candelari R, Alborino S, Marmorale C, Landi E. Pseudoaneurysm of the common hepatic artery: treatment with a stent-graft. Cardiovasc Intervent Radiol 2000; 23 (6) 472-474
• 49 Tokue H, Takeuchi Y, Sofue K, Arai Y, Tsushima Y. Ultrasound-guided thrombin injection for the treatment of an iatrogenic hepatic artery pseudoaneurysm: a case report. J Med Case Reports 2011; 5: 518
• 50 Minaya Bravo AM, González González E, Ortíz Aguilar M, Larrañaga Barrera E. Two rare cases of intrahepatic subcapsular hematoma after laparoscopic cholecystectomy. Indian J Surg 2010; 72 (6) 481-484
• 51 Fusco MA, Scott TE, Paluzzi MW. Traction injury to the liver during laparoscopic cholecystectomy. Surg Laparosc Endosc 1994; 4 (6) 454-456
• 52 Fidelman N, Kwan SW, LaBerge JM, Gordon RL, Ring EJ, Kerlan Jr RK. The transjugular intrahepatic portosystemic shunt: an update. AJR Am J Roentgenol 2012; 199 (4) 746-755
• 53 Lin TS, Chiang YC, Chen CL , et al. Intimal dissection of the hepatic artery following transarterial embolization for hepatocellular carcinoma: an intraoperative problem in adult living donor liver transplantation. Liver Transpl 2009; 15 (11) 1553-1556
• 54 Gupta N, Solomon H, Fairchild R, Kaminski DL. Management and outcome of patients with combined bile duct and hepatic artery injuries. Arch Surg 1998; 133 (2) 176-181
• 55 Kumar A, Ahuja CK, Vyas S , et al. Hepatic arteriovenous fistulae: role of interventional radiology. Dig Dis Sci 2012; 57 (10) 2703-2712