Gall bladder removal is very commonly done when patients get repeated bouts of pain on their right side from gall stones that block the flow of bile. Sometimes the gall bladder, which is a storage tank for the bile made by the liver, becomes inflamed and if it isn’t removed promptly, it can burst open and cause life-threatening infection in the abdomen. More commonly, patients elect for gall bladder surgery when they can no longer put up with the severe pain that comes from gall stones, which are crystals of bile. Whatever the reason for the gall bladder surgery, malpractice issues can arise if the patient suffers an injury to the tubes carrying bile.
These tubes are called bile ducts. They transport bile from the liver, where bile is made, to the intestines, where bile breaks down fat. No one can live without bile, so keeping the blow of bile from liver to intestines is essential to life.
There are two simple rules that prevent most bile duct catastrophes:
- First, if the surgeon isn’t sure what he’s cutting (the anatomy sometimes is variable in its layout, or there is a lot of scar tissue), he should take steps to make sure what is the correct tube to cut. One way to do this is to “convert” the procedure from laparoscope, with video cameras, to an “open” procedure where the surgeon can see the anatomy with the naked eye and can follow the tube back to their origin. The second way to do this is to inject dye into the tube system and take an x-ray picture: a cholangiogram.
- The second technique that avoids catastrophe is to take another x-ray picture at the end of the case to make sure the bile duct system is intact and there is no bile spilling.
There is an entire specialty of surgeons, biliary surgeons, whose main work involves fixing the injuries that other surgeons have caused to the bile ducts. If this repair isn’t done right, the bile ducts can become scarred and inflamed, and that can restrict the flow of bile from the liver to the intestines, which can again threaten the patient’s life. So another area of malpractice concern is in the adequacy of the repair of a bile duct injury – even if the original injury is not considered malpractice in itself. But it can take at least a year or two to know how adequate the bile duct repair is.
Patient safety tip for patients who have just suffered a bile duct injury from surgery
If the surgeon hasn’t fixed it yet, consider asking to be sent to a biliary surgeon, who has vastly more experience putting bile ducts back together. When bile duct repair isn’t done right, the duct can become repeatedly inflamed or can scar shut, and that can be life-threatening.
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