ED treatment includes antibiotics for cholangitis and supportive care. 15  A biliary stricture occurs in approximately 10% of post-cholecystectomy bile duct damage repairs.16  Strictures result from intraoperative damage to the bile duct leading to inflammation, fibrotic changes, narrowing of the lumen, and ultimately post-hepatic biliary obstruction. Initially a percutaneous aspiration under US guidance is performed. Although immediate consultation with a surgeon should be performed, current literature demonstrates poorer outcomes if patients with peritonitis are taken for immediate surgical correction of the bile duct injury.14  Once stable, or if the presenting non-septic, patients should be evaluated for a corrective procedure with either a hepaticojejunostomy or end-to-end anastomosis.14. Although there are some nuances regarding the most common complications, the initial workup of the majority of post-cholecystectomy complications begin with a complete blood cell count and liver enzymes that include a differentiated bilirubin. Laparoscopic Cholecystectomy: Minimal access surgery has revolutionized the modern surgical sciences by bringing in innovativeness and superior technology. Liver injury. Infection. Surgery or Endoscopy? This is usually attributed to bile salts. Within clip failure over the cystic duct, bile flows into the peritoneal cavity. Postponed bleed or secondary bleed follows localized infection resulting in vascular erosion. Laparoscopic . 8 Halevy A, Gold-Deutch R, Negri M, Lin G, Shlamkovich N, Evans S, Cotariu D, Scapa E, Bahar M, Sackier JM. The American Journal of Surgery. Bile is an excellent culture moderate for bacteria. Recognizing complications after laparoscopic cholecystectomy as soon as possible is advantageous because doing so allows prompt intervention and in turn may lead to an improved patient outcome [].To achieve this, a low threshold for requesting imaging studies is necessary, which is likely to result in many imaging studies that simply show the normal sequelae of laparoscopic cholecystectomy. From time to time through vault of vagina, rectal wall or abdominal wall leading to localised abscess, when drained discharges gall stones. Are elevated liver enzymes and bilirubin levels significant after laparoscopic cholecystectomy in the absence of bile duct injury? 19 Machado, NO. The frequency of enterohepatic circulation of bile salts increases after … Late complications of bile duct injury are biliary cirrhosis, portal hypertension and it is complications ending in liver failure. Unlocking Common ED Procedures: Approach to the Patient with Difficult Vascular Access, Subtle Presentations of Shock in the ED Setting, R.E.B.E.L. American Journal of Roentgenology. The frequency of severity grade 1 complications was equal after open and laparoscopic cholecystectomy (5.6%), but major complications (grade 2 and higher) were significantly more frequent in the open group (10.4 versus 3.6%). 25 Jabbari NA, Hassanpour M, Jangjoo A. A few people are prone to an internal infection post the surgery. in obese patients particularly in the umbilical port. 11 Lee CM, Stewart L, Way LW. Cholecystectomy. Cholecystectomies are one of the most common procedures performed in the United States, with approximately 750,000 operations each year.1  Indications for cholecystectomy include gallstone cholecystitis, acalculous cholecystitis, symptomatic gallstones, biliary dysfunction, gallstone pancreatitis, polyps, and concern for malignancy.1,2  Since the 1990s, a laparoscopic approach has replaced the open approach as the gold standard, though approximately 5% of laparoscopic procedures are converted to an open technique.3  In the laparoscopic technique, small abdominal incisions are made, allowing ports for insufflation, cameras, and surgical tools; this is in contrast to an open cholecystectomy where approximately a 6 inch incision is made near the site of the gallbladder.4  Per the Center for Disease Control, the rate of cholecystectomies as an outpatient has nearly matched the rate performed as an inpatient—approximately 22 in 10,000 inpatient discharges and 21 in 10,000 ambulatory surgery visits documented cholecystectomy as a coded procedure.5  With this high rate of cholecystectomies being performed, especially in the setting of the increasing number as an outpatient, emergency providers should understand several potential complications. 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