Ultrasound Diagnosing of Iatrogenic Damage of Bile Ducts

Purpose: to study the ultrasound features of iatrogenic injuries of bile ducts in different terms of postoperative period and to identify the typical variations of the echographic image. Materials and methods. 46 patients who suffered from iatrogenic injury in different terms of cholecystectomy have been examined and treated. Iatrogenic injury of bile ducts was revealed among 12 (26%) patients during the operation, within 7 days - among 15 (33%) patients, within a month - among 8 (17%) patients, and cicatricial stricture of bile ducts in late postoperative period was revealed among 11 (24%) patients within the terms from a month to 16 years. The injuries of bile ducts were the following: ducts crossing took place among 10 (22%) patients, excision - among 14 (31%) patients, peripheral injury - among 7 (15%) patients, thermal injury - among 2 (4%) and it was not possible to identify the nature of the injuries among 13 (28%) patients. The patients were examined by means of the standard methods of sonography of abdominal cavity organs and the scanner settings. Results. In the course of the ultrasound examination 23 patients have been diagnosed to have an iatrogenic injury of bile ducts in the postoperative period, 16 patients have been revealed to have postoperative cicatricial stricture of bile ducts. In relation to a "fresh" iatrogenic injury an expansion of bile ducts has been observed in 61% of cases, changes in the opening of bile ducts - in 74% of cases, free fluid and limited liquid accumulations - in 65% and 52% of cases correspondingly. The increase of echogenicity of the ligamentous apparatus and cellular tissue structures of subhepatic recess has been revealed in 83% of cases during the ultrasound examination. Within a "fresh" iatrogenic injury three most frequent variations of echographic image have been marked out. Ultrasound features of postoperative cicatricial strictures of bile ducts have been summarized. Conclusion. Due to the accomplished research the ultrasound symptom complex within an iatrogenic injury in different terms after the surgery has been studied. On the basis of the analysis of the ultrasound features combination it was possible to reveal the most typical echographic images which are specific for iatrogenic injuries of bile ducts in early terms of postoperative period. The ultrasound examination, in conjunction with other radiological methods, has allowed to choose the optimum minimally invasive surgical tactics, to carry out transcutaneous maneuvers under the ultrasound visual control as a preparatory stage in the treatment of iatrogenic injuries of bile ducts.

желчные протоки, ятрогенная травма, стриктура, ультразвуковая диагностика, bile ducts, iatrogenic injury, stricture, ultrasound diagnosing

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