MANAGEMENT AND OUTCOME OF PATIENTS WITH COMBINED BILE-DUCT AND HEPATIC-ARTERY INJURIES

Background: Major bile duct injury is an important therapeutic problem that can be associated with simultaneous injury to the hepatic artery . Limited information exists regarding the course of patients who have combined bile duct and arterial injuries. Objective: To compare the m anagement and outcome of isolated bile duct injuries with bile duct an d hepatic artery injuries. Patients and Methods: Since 1991, 13 patien ts have undergone reconstruction of right and left hepatic confluence or proximal bile duct injuries. At the time of bile duct injury, 4 of these patients had simultaneous occlusion or extirpation of the right hepatic or common hepatic artery. All patients underwent reconstructio n of the biliary tract with hepaticojejunostomies. The immediate and l ong-term outcomes of the patients with and without hepatic artery inju ry were compared. Results: In the immediate postoperative period, 3 of 4 patients with combined injuries had hepatic necrosis and/or abscess es with 2 patients requiring transcutaneous or operative drainage. Thi s problem was not diagnosed in patients with isolated bile duct injuri es. None of the biliary anastomoses have failed in the patients with i solated bile duct injuries while 50 % of the anastomoses in patients w ith combined injuries have caused recurrent problems following reconst ruction. Conclusion: Patients with major bile duct injuries should be evaluated for concomitant hepatic arterial injury as management and ou tcome may be influenced by the absente of arterial blood flow to the i njured bile ducts and to the liver.