Why do bile duct injuries occur?
Bile duct injuries can occur as a result of procedures to investigate or operate upon problems relating to the biliary system around the liver and small intestine, involving the gallbladder and bile duct. Subsequent problems can be life-threatening, so prompt diagnosis is vital.
Gallbladder Surgery
Bile duct injury is a known risk of gallbladder surgery. This operation (a cholecystectomy) is a very common operation and it is thought that complications only tend to arise in approximately 1 in 500 operations. However, they can be extremely problematic when they do occur.
Injuries to the bile duct may occur during gallbladder surgery for a number of reasons:
- The anatomy of the abdomen in which the bile duct exists can be both varied and complex. The purpose of the bile duct is to carry bile from the liver to the small intestine to assist in the digestion of food so it is, therefore, connected to the gallbladder which stores the bile. However, the way in which the bile duct attaches to the gallbladder can vary and, therefore, present unexpected complications to the surgeon, leading to an incorrect incision. Some of these forms of attachment can make the removal of the gallbladder a dangerous operation.
- Gallbladder removal is increasingly carried out by keyhole surgery (laparoscopy) which can sometimes mean that the field of vision for the surgeon is not sufficient to ensure a safe operation. The surgeon needs a clear view of the gallbladder bed and all surrounding structures – given that the anatomy can vary - to ensure that the nature of the attachments is clear and that only the correct incisions are made.
- Inflammation of the operation site can also occur, obscuring the surgeon's view of the gallbladder and surrounding structures.
- Lack of familiarity with the laparoscopic technique could also be associated with the occurrence of bile duct injuries but that should be less of a factor as keyhole surgery has become increasingly common.
An ERCP Examination Error
A bile duct injury can also occur as a result of a mismanaged ERCP (Endoscopic Retrograde Cholangio-Pancreatography). This is a procedure which allows the examination of the gallbladder, liver and bile duct by passing a small tube, with a camera attached, through the mouth and stomach to the top of the small intestine.
Other procedures may be carried out during this process such as the removal of stones from the bile duct and a sphincterotomy.
It is a procedure that carries a risk of complications, from minor to severe, and should only be used when other methods, such as an endoscopic ultrasound, have proved unsuccessful or are not suitable for the required outcome. One of the possible serious complications is the perforation of the bile duct, which can lead to a leakage of bile into the abdomen, causing peritonitis and sepsis.
Spotting and responding to an injury to the bile duct
Injury to the bile duct is a known risk of gallbladder surgery and a patient should be asked to consent to the procedure with that knowledge. However, a failure to recognise that an injury has occurred will mean that it will not be addressed at the time, therefore leading to on-going complications. Where the field of vision is inadequate or where an injury has occurred, it may be preferable for the surgeon to abandon the laparoscopy and opt for open surgery.
What are the signs of a bile duct injury?
If the injury is not observed during the operation, the patient might begin to experience a range of symptoms following the operation such as abdominal pain, nausea, vomiting and a fever.
In this situation, immediate investigations are necessary to identify the cause of the problem.
Why is a bile duct injury a problem?
The complications caused by a bile duct injury depend on the nature of the injury. The bile duct may be cut, pinched/strictured or burned, causing different effects.
If the bile duct is cut, this may lead to a leakage of bile into the abdomen. This can cause abdominal pain and ultimately lead to peritonitis if infection sets in, potentially leading to septic shock. This means that an injury to the bile duct can be fatal.
It will, of course, also mean that further, complex surgery will be necessary to repair the bile duct.
If the bile duct is inadvertently pinched, it can lead to an obstruction of the functioning of the bile duct, causing abdominal pain and jaundice.
The further operations necessary to repair or reconstruct the bile duct can, in themselves, cause further on-going problems.
Is a bile duct injury a sign of medical negligence?
As mentioned earlier, an injury to the bile duct is a known risk of gallbladder surgery. However, some types of injury should never occur and some approaches to the operation might be considered to be negligent. For instance, where an injury occurs but the surgeon is not sufficiently diligent in examining the operation site for evidence of an injury, medical negligence might be considered to have occurred.
Likewise, bile duct injury is a risk of an ERCP and this procedure should not be carried out unless procedures are required that cannot be achieved by other methods, such as the insertion of stents or removal of stones from the bile duct.
Speak to a solicitor
Glynns Solicitors are a team of specialist, medical negligence solicitors. If you have suffered from the effects of a bile duct injury which you believe may have been negligently caused or treated, contact us to discuss your circumstances and whether it may be appropriate for you to pursue a claim for compensation.
Call us free on 0800 234 3300 (or from a mobile 01275 334030) or complete our Online Enquiry Form.
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