Bile Duct Injuries

Overview

Bile duct injuries are injuries to the small tubes in the abdomen that transport a fluid produced by the liver called bile that helps digest fats in the intestine. 

The most common cause of bile duct injury is trauma to a bile duct during laparoscopic cholecystectomy (AKA gallbladder surgery). Laparoscopic surgery is a less-invasive surgical technique that utilizes instruments passed into the abdominal cavity through small incisions in the body. 

During surgery, bile ducts can accidentally get twisted, cut or burned, resulting in what’s known as a bile duct stricture. A bile duct stricture is caused by the narrowing or blockage of a bile duct, often due to the formation of scar tissue as the body tries to heal the injury. Narrowed or blocked bile ducts prevent bile from draining into the intestine as it should during digestion. As a result, bile accumulates in the bile ducts, backs up into the liver and can eventually enter the bloodstream, causing serious illness. 

A bile duct injury can also cause what’s called a biliary leak, in which bile drains into the abdominal cavity. Injury to the hepatic artery — the blood vessel that supplies blood to the liver– is also somewhat common in patients with bile duct injury, happening in about 20% of cases where bile duct injury occurs

Laparoscopic cholecystectomy is performed more than 750,000 times per year in the U.S. Bile duct injury during these surgeries is rare, estimated to occur in less than 1% of procedures.

Why Hoag for Bile Duct Injury Treatment in Orange County?

While bile duct injury is rare, it’s a serious issue and potentially life-threatening if not treated promptly by a center with the tools, techniques and experience to alleviate the symptoms and fix the injury right the first time. 

In Orange County, that center is The Hoag Digestive Health Institute. Hoag is the most comprehensive and experienced hepatobiliary program in Orange County, offering advanced, hyper-accurate diagnosis and next-generation treatment options for serious conditions of the bile ducts, pancreas, liver and gallbladder.

There’s a reason why U.S. News and World Report has named Hoag to their Best Hospitals list in the field of Gastroenterology and GI Surgery. Better and more personalized care. Advanced imaging to pinpoint problems and drive personalized treatment. A program that sees you as more than just your condition.

Diagnosed with a bile duct injury, or have symptoms you believe might suggest that’s the case? Don’t wait. When minutes count and your health is on the line, trust Hoag Digestive Health Institute to help you heal. 

Symptoms and Causes of Bile Duct Injury

While some bile duct injuries are recognized and treated during the surgery in which they occur, most are not diagnosed until the patient fails to progress toward recovery on schedule following the laparoscopic cholecystectomy procedure. If not treated promptly, bile duct injury can potentially be life-threatening. 

Symptoms of bile duct injury can include: 

• Bile draining from an incision, or from a surgical drain left in place during  laparoscopic cholecystectomy  
• Fever
• Abdominal pain
• Nausea and vomiting
• Itchy skin (AKA pruritus)
• Loss of appetite
• Obstructive jaundice, which is a yellowing of the skin and eyes due to a blocked bile duct causing excess bilirubin in the blood
• Sepsis, which is a life-threatening infection that can happen in cases of biliary leakage
• intra abdominal abscesses
• Cholangitis, which is an infection of the bile duct due to blockage. Read more about cholangitis.
• Secondary biliary cirrhosis, which is chronic inflammation and scarring of the bile ducts in the liver

Risk Factors

While an estimated 80% of bile duct injuries happen to patients with no known risk factors, there are certain traits believed to make certain people more prone to bile duct injury during laparoscopic cholecystectomy. These include: 

• Having a bile duct system with unique anatomy
• Severe obesity, which can limit the surgeon’s ability to see anatomical structures inside the abdomen
• Previously having hepatobiliary surgery to treat issues of the liver, pancreas, gallbladder and/or bile ducts
• Having underlying liver disease
• Having inflammation due to acute cholecystitis, which is when a blockage — usually a gallstone — causes bile to become trapped in the gallbladder. 

Diagnosis and Tests for Bile Duct Injury

Some bile duct injuries are recognized during the surgery in which they happen. Most, however, aren’t detected until the patient fails to completely recover following laparoscopic cholecystectomy surgery. 

If your doctor feels you have a history and symptoms that are consistent with a bile duct injury, there are imaging tests that can be used to diagnose the condition. These include:

• Abdominal ultrasound, which uses low-frequency sound waves to create images of the inside of the abdomen, including fluid collection that can signal a bile duct injury  
• Cholangiography, which is a special X-ray technique that utilizes a special dye called contrast medium to make the bile ducts and any obstructions of them easier to see. 
• Endoscopic retrograde cholangiopancreatography (ERCP), which is a diagnostic procedure that utilizes X-rays and a technique known as upper gastrointestinal endoscopy to diagnose and potentially treat issues associated with the bile ducts. 
• Magnetic Resonance Cholangiopancreatography (MRCP), which utilizes powerful magnetic fields, radio waves and advanced computing to evaluate the gallbladder, liver, bile ducts, pancreas and pancreatic duct for disease, without the use of ionizing radiation

Advanced Diagnostic Imaging for Hepatobiliary Conditions at Hoag

At the Hoag Digestive Health institute, we’re committed to giving every patient the understanding, care and treatment options we’d want for ourselves or a family member facing a serious illness. 

Conditions involving the bile ducts, liver, gallbladder and pancreas are often hard to diagnose without a deep, nuanced understanding of each individual system and how they work together. That’s why you need a fully-integrated and experienced liver team with the tools and techniques to spot subtle signs, and the next-generation technology to make an accurate diagnosis fast.

At Hoag, some of the advanced imaging techniques we use to diagnose hepatobiliary conditions include: 

• Endoscopic retrograde cholangiopancreatography (ERCP), which is a diagnostic procedure that utilizes X-rays and a technique known as upper gastrointestinal endoscopy to diagnose and potentially treat issues associated with the bile ducts, including in cases of bile duct injury. 
• Magnetic Resonance Cholangiopancreatography (MRCP), which utilizes powerful magnetic fields, radio waves and advanced computing to evaluate the bile ducts, gallbladder, liver, pancreas and pancreatic duct for disease, without the use of ionizing radiation
• Hepatobiliary iminodiacetic acid (HIDA) scanning, which is an advanced imaging technique which utilizes an injected radioactive tracer to diagnosis issues with the bile ducts, liver and gallbladder
• FibroScan^®, (AKA transient elastography), which is the first FDA-approved device in the U.S. that provides a painless, non-invasive method of testing for liver scarring without the side effects and complications of a needle biopsy.  Learn more about FibroScan®
• Attenuation Imaging (ATI) for Fat Quantification, which is an imaging technique used for quantifying fat deposition in the liver in real time
• Magnetic Resonance Elastography (MRE), which is used to detect stiffening of the liver caused by scarring and inflammation. This technology combines MRI imaging with low-frequency vibrations to create a visual map called an elastogram that shows the degree of stiffness of body tissues. 
• Magnetic Resonance Multi-Echo Dixon Vibe Liver Iron Quantification, which is a 3D imaging technique used to simultaneously assess fatty liver disease and abnormal iron levels in patients with chronic liver disease. 
• Magnetic Resonance Proton Density Fat Fraction (MRI-PDFF), which is an emerging imaging technique that accurately measures the amount of fat in liver tissue by correcting factors that can degrade or skew magnetic resonance signal intensity

Management and Treatment for Bile Duct Injury

Because a bile duct injury can result in potentially life-threatening complications, it’s imperative that patients seek the help of specialists, usually at a large, well-staffed center that has deep experience treating the biliary system and bile duct injuries. 

Treatment options for bile duct injury can include: 

• Drainage of excess bile from the blocked duct
• Placement of a surgical drain in the abdomen
• Dilation of the blocked bile duct and the placement of a stent, which is a special tube designed to hold the bile duct open
• Surgical biliary tract reconstruction, which can be performed either laparoscopically or “open,” meaning through an incision in the abdomen. 

Prevention of Bile Duct Injuries

Because most bile duct injuries occur during surgery through no fault of the patient, the best way to reduce your risk of a bile duct injury is to make sure any surgery or invasive procedures involving your bile ducts — including gallstone removal and gallbladder surgery — is done by a large, well-staffed treatment center with advanced imaging techniques and a long track-record of experience treating hepatobiliary conditions.