Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 7, 2015; 21(9): 2854-2857
Published online Mar 7, 2015. doi: 10.3748/wjg.v21.i9.2854
Common bile duct injury by fibrin glue: Report of a rare complication
Yu-Long Yang, Cheng Zhang, Hong-Wei Zhang, Ping Wu, Yue-Feng Ma, Mei-Ju Lin, Li-Jun Shi, Jing-Yi Li, Mu Zhao
Yu-Long Yang, Cheng Zhang, Hong-Wei Zhang, Ping Wu, Yue-Feng Ma, Mei-Ju Lin, Li-Jun Shi, Jing-Yi Li, Mu Zhao, Department of Biliary Minimally Invasive Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, Liaoning Province, China
Author contributions: Zhang C performed literature search and drafted the manuscript; Yang YL conceived the idea and critically revised the manuscript; Wu P critically revised the manuscript; Yang YL, Zhang HW, Ma YF, Lin MJ, Shi LJ, Li JY and Zhao M performed the surgery.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yu-Long Yang, MM, PhD, Department of Biliary Minimally Invasive Surgery, Affiliated Zhongshan Hospital of Dalian University, 6 Jiefang Street, Zhongshan District, Dalian 116001, Liaoning Province, China. yyl516@126.com
Telephone: +86-411-62893656 Fax: +86-411-62893555
Received: July 31, 2014
Peer-review started: August 2, 2014
First decision: August 15, 2014
Revised: October 30, 2014
Accepted: November 30, 2014
Article in press: December 1, 2014
Published online: March 7, 2015
Processing time: 220 Days and 20.5 Hours
Abstract

Fibrin glue is widely used in clinical practice and plays an important role in reducing postoperative complications. We report a case of a 65-year-old man, whose common bile duct was injured by fibrin glue, with a history of failed laparoscopic cholecystectomy and open operation for uncontrolled laparoscopic bleeding. In view of the persistent liver dysfunction, xanthochromia and skin itching, the patient was admitted to us for further management. Ultrasound, computed tomography, and magnetic resonance cholangiopancreatography (MRCP) revealed multiple stones in the common bile duct, and liver function tests confirmed the presence of obstructive jaundice and liver damage. Endoscopic retrograde cholangiopancreatography was unsuccessfully performed to remove choledocholithiasis, but a small amount of tissue was removed and pathologically confirmed as calcified biliary mucosa. This was followed by open surgery for suspicious cholangiocarcinoma. There was no evidence of cholangiocarcinoma, but the common bile duct wall had a defect of 8 mm × 10 mm at Calot’s triangle. A hard, grid-like foreign body was removed, which proved to be solid fibrin glue. Subsequently, the residual choledocholithiasis was removed by a choledochoscopic procedure, and the common bile duct deletion was repaired by liver round ligament with T-tube drainage. Six months later, endoscopy was performed through the T-tube fistula and showed a well-repaired bile duct wall. Eight months later, MRCP confirmed no bile duct stenosis. A review of reported cases showed that fibrin glue is widely used in surgery, but it can also cause organ damage. Its mechanism may be related to discharge reactions.

Keywords: Fibrin glue; Laparoscopic cholecystectomy; Choledocholithiasis; Bile duct injury; Liver round ligament; Obstructive jaundice; Choledochoscope

Core tip: Fibrin glue is a biodegradable and absorbable biological agent, which can be used to close wounds and fistulous tracts, reducing leakage and bleeding, promoting wound healing, and preventing adhesion. It is widely used in surgery. In our case, fibrin glue resulted in obstructive jaundice and injury of the common bile duct wall, which was repaired by liver round ligament without bile duct stricture. Its mechanism may be related to discharge reactions.