Published online Apr 27, 2016. doi: 10.4240/wjgs.v8.i4.335
Peer-review started: May 8, 2015
First decision: August 4, 2015
Revised: November 24, 2015
Accepted: February 23, 2016
Article in press: February 24, 2016
Published online: April 27, 2016
Core tip: Inadvertent duodenal injury is a rare potentially fatal complication of laparoscopic cholecystectomy. Such injuries often go unrecognized at the time of the procedure and manifest later with significant morbidity and mortality. Literature review revealed 74 cases of duodenal injury. The injury was caused by cautery in 46%, dissection in 39% and retraction in 14% of the cases. The predominant site of injury was to the 2nd part in 61% and in 31% to 1st part. Duodenorapphy was the primary treatment carried out in 63% of the cases among which 21% was laparoscopically. When detected on table, 88.9% survived in contrast to 76.5% detected later. Overall mortality was 18%. The major impact of this review in clinical practice is in emphasizing the need for prompt detection of a potential duodenal injury in every patient who has unexplained postoperative course following a difficult laparoscopic cholecystectomy due to gall bladder adhesions or dissection. The change of clinical practice it should lead to is an attempt by surgeons in early detection of potential duodenal injury in such patients, which could be achieved by estimating the amylase content in subhepatic fluid collection or by upper gastrointestinal contrast studies. It also highlights the need for immediate surgical repair as any delay beyond the first postoperative day has adverse effect on outcome.