Balderas-Montoya C, Alvarado-González A, Rosas-García CR, Balcázar-Hurtado A, Lerma-Alvarado RM, Aburto-Fernández MC

Language: Spanish
References: 9
Page: 96-100
PDF size: 1408.04 Kb.

ABSTRACT

Introduction: this article reports a case of a complication following the surgical repair of an iatrogenic bile duct injury, highlighting the utility of intraoperative enteroscopy as a diagnostic and decision-making tool during reintervention. Clinical case: a 32-year-old female patient with a post-cholecystectomy Strasberg type E1 bile duct injury was initially managed with endoscopic retrograde cholangiopancreatography (ERCP) and subsequent Roux-en-Y hepaticojejunostomy. After an initially favorable progression, she presented with deterioration characterized by severe progressive anemia (hemoglobin 6.2 g/dL), obstructive jaundice, and coagulopathy. Abdominal computed tomography suggested intraluminal hemorrhage. During reintervention, a 600 mL clot was drained from the bilioenteric loop. Intraoperative enteroscopy was performed, allowing evaluation of the mucosa and confirmation of hemostasis, leading to the choice of a conservative management approach. Subsequent progression was favorable, with improvement in clinical and biochemical parameters. Conclusion: anastomotic hemorrhage with obstructive clot formation is a serious complication of biliary reconstructive surgery. Intraoperative enteroscopy proved to be an invaluable tool in intraoperative management, allowing precise assessment and guiding a conservative approach with a successful outcome. This case reinforces the need for a high index of suspicion for hemobilia and the value of a multidisciplinary approach.

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