Page 46 - WALS Journal

World Journal of Laparoscopic Surgery, May-August 2008;1(2):49-51
Common Bile Duct Injury in Laparoscopic Cholecystectomy—Inherent Risk of Procedure or Medical Negligence
Common Bile Duct Injury in Laparoscopic

Cholecystectomy—Inherent Risk of Procedure

or Medical Negligence—A Case Report

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

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

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