Management of Post-Cholecystectomy Double Trouble: Bile Duct Injury with Incidental Gallbladder Cancer

Postoperative course of cholecystectomy may be complicated by bile duct injury (BDI) or incidental gallbladder cancer (GBC). These two problems have been reported in isolation with many unresolved management issues. However, management of patients having both of these problems concurrently has not been reported earlier. Aim of the present study was to evaluate the management and outcome of patients presenting with coexistent BDI and GBC. Retrospective analysis of database from January 2009 to December 2015 to performed to identify patients having both post-cholecystectomy BDI as well as incidental GBC. This cohort was analyzed with respect to clinical presentation, management and outcomes. Seven patients (six females, mean age 45.3 ± 15.7 years) were identified to have coexistent BDI and incidental GBC. This group constituted 7.7% (7/91) among post-cholecystectomy BDI, 1.3% (7/506) among GBC, and 18% (7/39) among incidental GBC seen during the same period. Patients presented after a mean interval of 37.6 ± 22.9 days after cholecystectomy. Most (6/7) presented with bile leak. Five underwent surgery after a mean interval of 86.6 ± 54.8 days, and radical re-resection could be performed in only 2 of these with simultaneous hepaticojejunostomy in one patient for biliary injury. Overall residual/recurrent was disease was found in 57% (4/7). Coexistent BDI and incidental GBC is a rare post-cholecystectomy problem. Rate of curative re-resection is low either due to high residual/recurrent disease or due to associated biliary injury precluding safe re-exploration. Study of large cohort is imperative to know the best management plan for this subset of patients.