Biliary injury

A 50-year old woman was referred to a consultant general surgeon with a history of intermittent right upper quadrant pain. An ultrasound scan revealed gallstones and a shrunken gallbladder.

Before the surgery, the patient signed a consent form which listed the risks of the procedure as bile duct injury and bleeding, as well as the possible need to convert to an open procedure.

At operation, the surgeon found significant inflammation around the common bile duct and cystic duct. He identified the cystic duct, clipped it at the gallbladder, and performed a cholangiogram which demonstrated free flow of contrast into the duodenum. The surgeon was satisfied that he had correctly identified the cystic duct, and placed another clip across it and divided it before dissecting the gallbladder and completing the procedure.

Post-operatively the patient developed pyrexia and jaundice.

The surgeon arranged an ERCP which showed leakage of contrast from the common bile duct, and no filling of the common hepatic duct or intrahepatic ducts. The patient required urgent surgical repair and a clip was found across the common bile duct. Unfortunately the patient had a complicated post-operative course and a prolonged stay in hospital.

The patient brought a claim against the surgeon, alleging that, having identified the inflammation around the common bile duct and cystic duct, he should have realised that the procedure was not straightforward and converted to an open procedure before attempting to clip the cystic duct. By failing to do so, he had clipped and divided the common bile duct, resulting in significant injury to the biliary tree.

The MDU obtained advice from a general surgery expert who advised that biliary injury should not be regarded as negligent because it is a recognised complication of this surgery, and the claimant had clearly been warned of this risk. However, in this case, the common bile duct had been clipped suggesting that the surgeon had not correctly identified the anatomy. There was a failure to recognise the biliary injury intra-operatively, and there should have been a decision to convert to an open procedure.

The expert advice was discussed with the member, and it was decided that it would not be possible to successfully defend the claim. The claim was settled on behalf of the member for £85,000.

This page was correct at publication on 29/11/2012. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.