WOFAPS 2025 8th World Congress of Pediatric Surgery

Nahla Kechiche ¹, Nouha Boukhrissa ¹, Sawsen Chakroun ², Mongi Mekki ¹, Lassaad Sahnoun ¹

¹ Pediatric surgery department, Fattouma Bourguiba Hospital, Monastir, Tunisia
² Pediatric anaesthesia and intensive care department, Fattouma Bourguiba Hospital, Monastir, Tunisia

Introduction:
Laparoscopic cholecystectomy is widely regarded as the standard of care for symptomatic gallbladder disease in pediatric populations. Although rare, iatrogenic bile duct injury (BDI) remains one of the most severe complications, with potentially life-threatening consequences. Pediatric data on this topic are scarce, and awareness is limited. We report a series of three major BDIs occurring during laparoscopic cholecystectomy in children, highlighting diagnostic challenges and surgical management strategies.

Results:
Three children (aged 9-11 years) presented postoperatively with signs suggestive of bile duct injury. The initial postoperative course was marked by nonspecific symptoms including abdominal distension, persistent bilious drainage, vomiting, and in one case, acholic stools. Imaging studies ultrasound and CT scans revealed significant intraperitoneal fluid collections and postoperative changes, suggesting bile leakage or incomplete cholecystectomy.
Surgical exploration in all three cases revealed major bile duct injuries. One child had a complete transection of the common hepatic duct, another had a posterior bile duct laceration with residual gallbladder tissue, and the third had a full transection of the common bile duct. Management consisted of biliary-enteric reconstruction in all patients: two underwent Roux-en-Y hepaticojejunostomy with favorable outcomes, while the third, despite prompt surgical intervention, succumbed to postoperative septic complications.

Conclusion:
Major bile duct injuries during pediatric laparoscopic cholecystectomy, although infrequent, pose substantial diagnostic and therapeutic challenges. Clinical vigilance for early warning signs, timely imaging, and prompt surgical intervention are essential for favorable outcomes. This series underscores the critical importance of careful dissection and an in-depth understanding of pediatric biliary anatomy to minimize the risk of iatrogenic injury.