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World Journal of Laparoscopic Surgery, September-December 2008;1(3):28-30
Lalwani S et al
Common Bile Duct Injury in Laparoscopic

Cholecystectomy: Inherent Risk of Procedure or

Medical Negligence—A Case Report

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6
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1 Lalwani S, Misra MC, Bhardwaj DN, Rajeshwari S, Rautji R, Dogra TD
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4
1 Assistant Professor, Department of Forensic Medicine, AIIMS, New Delhi, India
2 Professor and Head, Department of Surgery, AIIMS, New Delhi, India
3 Additional Professor, Department of Forensic Medicine, AIIMS, New Delhi, India
4 Additional Professor, Department of Anaesthesia, AIIMS, New Delhi, India
5 Associate Professor, Department of Forensic Medicine, AFMC, Pune, India
6 Professor and Head, Department of Forensic Medicine, AIIMS, New Delhi, India
Correspondence: Sanjeev Lalwani, Assistant Professor, Department of Forensic Medicine, AIIMS, New Delhi, India
E-mail: drsalal@rediffmail.com, sanjulalwani2001@yahoo.com

Abstract stable vitals. The central nervous system, cardiovascular system
and respiratory system were normal on examination. Abdominal
We present a case report of common bile duct injury which occurred in
a patient who underwent laparoscopic cholecystectomy for examination showed slight tenderness in the right hypo-
cholecystitis and cholelithiasis. The patient died within 96 hours of chondrium. There was no organomegaly or free fluid. Ultra-
the surgery. The case was investigated by the police as the relations of sonography revealed acute cholecystitis with cholelithiasis.
the victim alleged death due to negligence on the part of treating doctors. Laboratory investigations were within normal limits.
The clinical details, autopsy findings, report of histopathological Laparopscopic cholecystectomy was performed on the next
examination and medicolegal aspects are discussed along with relevant day of admission under general anesthesia. During the surgery
literature. gallbladder was found to be thick walled with dense omental
Keywords: Cholecystectomy; common bile duct injury; negligence. adhesions. The Hartmann’s pouch was not well developed.
Gallbladder was sessile and Moynihan’s lump was present.
INTRODUCTION During dissection the common bile duct was accidentally
injured at the junction of gallbladder. The injury was identified
For more than a century classical cholecystectomy has been a immediately during the procedure. A second opinion of other
method of choice in surgical management of gallbladder disease. senior consultant was sought and it was decided to convert the
Laparoscopic cholecystectomy introduced in the late eighties, procedure to open through a right subcostal incision. The injury
has now become the gold standard and has taken the place of to common bile duct was repaired and a no. 12 T tube was
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conventional cholecystectomy. It is now the treatment of choice placed across the repair. Gallbladder was dissected out of its
2,3
for symptomatic gallstone disease. Though it is a very safe bed, haemostatis achieved, suction irrigation done and a no. 32
procedure, it does have its own morbidity and rarely mortality chest drain tube placed in the subhepatic region. The incision
due to numerous complications. 4
was closed in layers. The patient was shifted to the surgical
ICU. The gallbladder was sent for histopathological examination.
CASE REPORT
There was no anesthetic complication during the entire
A 44-year-old male patient presented to a private hospital with procedure. On the first and second postoperative day patient
the complaints of acute onset of pain in the right upper abdomen was afebrile and stable hemodynamically. He was kept on
for two days with 4-5 episodes of yellowish vomiting. He was intravenous fluids, antibiotics, analgesics and proton pump
examined by a surgeon and admitted to the hospital on the next inhibitors. Oral feeding was withheld.
day. As per clinical records, there was a history of dyspepsia On the third postoperative day patient developed oliguria.
with acid brash. The pain was radiating to right hypochondrium Urine output failed to respond to a fluid challenge. The opinion
and back. There was no history of jaundice and diarrhea. On of a physician was sought and the patient was shifted to
clinical examination, his general condition was satisfactory with Medicine ICU. A diagnosis of cholangitis with septicemia and

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