LESIONES DE LA VIA BILIAR IATROGNICASLaslesionesdevabiliardesafortunadamente nosonraras,yfrecuentementeseconvierten en tragedias.Grey-Turner. 1944VIAS BILIARES INTRAHEPATICAS:Se conforman or cana!"cu!o#Se $%er&en con'uc&%!!o# %n&ra!o(u!%!!are#Con$er)en con'uc&%!!o# (%!%are# er%or&a!e# Ana#&omo#an en&re #% ara formar con'uc&o# (%!%are# 'erec*o e %+,u%er'o.VIAS BILIARES E-TRAHEPATICASCHC=0.25-2.5cm superficieCHI =1.7CM CHD= 0.9CMCHC= 1.5CM-3.5CMCONDUCTOS HEPATICOS ANOMALOS: .ncon'uc&o*e/&%coa(erran&ee#un con'uc&o#e)men&ar%onorma!,ue#eune a!a#$"a#(%!%are#0u#&oafuera'e!*")a'o en!u)ar'e*acer!o%nme'%a&amen&e 'en&ro'e!m%#mo1'renaunaorc%2n norma! 'e! *")a'o. E#&econ'uc&o,uea#aa&ra$3#'e! &r%/n)u!o*ea&oc"#&%co4e#%mor&an&e or,ueue'e#ecc%onar#e'emanera %na'$er&%'acone!e#cae#u(#ecuen&e'e (%!%#.El cstico en su interior present un serie !e "#l"uls semilunres$ llm!s "#l"uls en espirl o !e HeisterAREAS ANATOMICAS:Fondo.Cuerpo.Infundbulo.Cuello.El fondo correponde ! l! eco"!dur! c"#c!.El cuerpo e rel!c#on! con l! e$und! porc#%n del duodeno.El cuello e encuen"r! !cod!do obre el cuerpo.PS 5 1-4C675 8cmPR 5 9-:C675 1.:PP5 1.: ; :C6 75 9cmPI5 ?E B.??@ENTRE C>N?.CT> CISTIC> P>R ?EBAA>B>R?E ?ERECH> C>N?.CT> HEPATIC> HACIA IBC.IER?AB>R?E INDERI>R HIGA?> HACIA ARRIBAARTERIA CISTICA*+ ,ecul! b#l#!r- .+ Conduc"o c"#co- /*+ H$!do. E!&r%/n)u!o*ea&oc"#&%co %nc!uye!aar&er%a*e/&%ca 'erec*aEyenoca#%one#una ar&er%a*e/&%ca'erec*a a(erran&eF4 !a ar&er%a c"#&%ca y a $ece#uncon'uc&o(%!%ar a(erran&e Eacce#or%oF.IRRI0ACION.L!1ecul!b#l#!r2loconduc"o &ep'"#co 3 l! porc#%n uper#or del duodenoe"'n#rr#$!doporl! !r"er#! c"#c!.Pro1#ene de l! &ep'"#c! derec&!. 4567869+/69 puede pro1en#r de un! !r"er#! !berr!n"e pro1en#en"e de l! (een"er#c! uper#or.or%)enen!a ar&er%a*e/&%ca 'erec*a4!acua! '%#curre &ran#$er#a!men&ea!a'erec*a a#an'oor 'e!an&e4 'e&r/# o a!a'erec*a'e! con'uc&o *e/&%coA.C.'o#rama#4una'erec*ayo&ra%+,u%er'a4 &erm%nan'oenunare''eGna#ar&er%o!a#4no#%n an&e#roorc%onarrama#co!a&era!e#'%r%)%'a#a $a#cu!ar%+ar !o# con'uc&o# (%!%are# e7&ra*e/&%co#DRENA:E ,ENOSO.Seefec")!! "r!1;de peGIATre#fac&ore#re)u!ane!Hu0o(%!%ar4 #ecrec%2n *e/&%ca4 con&racc%2n $e#%cu!ar y re#%#&enc%a 'e! e#f"n&er 'e! co!3'ocoEn ayuno !a re#%2n 'e! co!3'oco e# 'e : a 1< cm 'e a)uaLaco!e#%#&%c%n%nacon#&%&uyee!r%nc%a! e#&%mu!oG#%o!2)%coara!acon&racc%2n 'e!a$e#"cu!ayre!a0ac%2n'e!e#f"n&er4 fac%!%&a'o or %mu!#o# $a)a!e#BF Como#%c%2n 'e !a (%!%#Le#%2n $%a (%!%ar?EDINICI>NSe'eGne!a!e#%2n,u%rIr)%cacomo!a o(#&rucc%2nE!%)a'ura4c!%a'ooe#&eno#%# c%ca&r%+a!F4 #ecc%2n arc%a! o &o&a! 'e !a $"a (%!%ar r%nc%a! o 'e con'uc&o# a(erran&e# ,ue 'renan un #ec&or o #e)men&o *e/&%co.. Iatrogenic bile duct injuries: etiology, diagnosis and management. . ?orl! < @stroenterol 2012 Aep 7B15133208097-108. Iatrogenic bile duct injuries: etiology, diagnosis and management. . ?orl! < @stroenterol 2012 Aep 7B15133208097-1086ECANIS6>S ?E LESI>N8 )ruo# r%nc%a!e#: Proce'%m%en&o#,u%rIr)%co#'e!aVB Eco!ec%#&ec&om"aa(%er&ay!aaro#c2%caF4 co!e'oco&om"a y c%ru)"a (%!%ar re$%a.C%ru)"a#'eo&ro#2r)ano#e%)/#&r%co# Ere#ecc%2n)/#&r%ca4*e/&%ca4ancre/&%ca4 &ra#!an&e*e/&%co4#*unor&o;ca$a4 recon#&rucc%one#(%!%o'%)e#&%$a#4 !%nfa'enec&om"a#F.. Iatrogenic bile duct injuries: etiology, diagnosis and management. . ?orl! < @stroenterol 2012 Aep 7B15133208097-108DACT>RES ?E RIESG>InHamac%2n cr2n%ca er%$e#%cu!ar y 'e! !%)amen&o *ea&o'uo'ena!.>(e#%'a'.A(un'an&e )ra#a $%#cera!.Hemorra)%a.. Iatrogenic bile duct injuries: etiology, diagnosis and management. . ?orl! < @stroenterol 2012 Aep 7B15133208097-1086ECANIS6>S ?E LESI>N ; ERR>RES TECNIC>S?o# )ruo# r%nc%a!e#:1. Errore#'e%'en&%Gcac%2n'e!a ana&om"a'e!&rac&o(%!%ar4JS ?E LESIMN EN C>LECISTECT>6NA LAPAR>SC>PICAL%)a'urao#ecc%2n'e!con'uc&o(%!%ar e,u%$oca'o.Tracc%on e7ce#%$a4 &racc%2n cefa!%caLa !u+ 'e !a $"a (%!%ar r%nc%a! ue'e #eroc!u%'a &ra# !a !%)a'ura 'e! c"#&%co.C!%# %ncon&ro!a'o#. Da!!o en c!% c%#&%coLa%rr%)ac%2n'e!a$"a(%!%arr%nc%a!#e ue'ecomrome&er&ra#una'%#ecc%2n e7ce#%$a.C=lmnos I@$ Con 3$ /ir&s @3$ /ontsos .. Iatrogenic Injury of the extrahepatic bile ducts. Surgical reconstruction. In Crloiots CC$ /roelsc- CE$ H&ii& 3. 4i"er n! &ilir+ trct sur)er+. Em&riolo)icl ntom+ to 3D Im)in) n! trnsplnt inno"tions. @reci0 Aprin)er Derl)B 2012. p. 171 6 190.6ECANIS6>S ?E LESIMN EN C>LECISTECT>6NA LAPAR>SC>PICAV%#%2n monocu!ar..#o 'e e!ec&rocau&er%o cerca 'e! &r%/n)u!o 'e Ca!o&.Cur$a 'e aren'%+a0e 'e! c%ru0ano. La!u+'e!a$"a(%!%ar#e ue'e&rauma&%+ar&ra# una &racc%2n e7ce#%$a.C=lmnos I@$ Con 3$ /ir&s @3$ /ontsos .. Iatrogenic Injury of the extrahepatic bile ducts. Surgical reconstruction. In Crloiots CC$ /roelsc- CE$ H&ii& 3. 4i"er n! &ilir+ trct sur)er+. Em&riolo)icl ntom+ to 3D Im)in) n! trnsplnt inno"tions. @reci0 Aprin)er Derl)B 200%. p. 171 6 190.PRESENTACI>N CLINICA1. ?uran&e!ac%ru)"a.8:Kco!3'ocoycon'uc&o *e/&%co. Du)a %n&raoera&or%a (%!%#.8. Po#& oera&or%o &emrano menor a 1 #emana.9. :PERAT>RI>1:K no #e reconocen 'uran&e !a c%ru)"a.=: K #e $en con fu)a (%!%ar o er%&on%&%# (%!%ar #%n e$%'enc%a 'e erforac%2n 'e !a $e#"cu!a.OSo#ec*aP Con$er&%r!a.S%emre %'en&%Gcar $"a (%!%ar r%nc%a!.@oum D@. Eperti"e &ile !uct in5ur+. Aur)er+ 2013B 139-189P>SC.IR.RGIC> TE6PRAN>6a!e#&ar)enera!4n/u#ea#4Ge(re4&a,u%car'%a.Sa!%'a'e(%!%#or 'rena0e4 %c&er%c%a.B%!oma ue'e e#&ar an&e# 'e ,ue aare+can #"n&oma#.9.: a J '%a# o#&er%ore# a !a C7.8:K %c&er%c%a #%n 'o!or.6a# 'e! :CPRE?%a)n2#&%ca y &era3u&%ca.Efec&%$a en 9"r!&ep'"#co. Porc!nul!c#%n%na'$er&%'a 'e!*ea&o-co!3'oco'uran&e !area!%+ac%2n'e!a co!an)%o)raf"a.Atrs&er). An analisis of the problem in biliary injury during laparoscopic cholecystectomy. < .m Coll Aur) 2001B 1G00 101-125T#poE:le#%nc#rcunferenc#!ldeconduc"o b#l#!re (!3ore. Corre#on'e a !a c!a#%Gcac%2n 'e B%#mu&* 'e e#&eno#%# 'e !a $"a (%!%arE1 :&ran#ecc%2n a ma# 'e 8 cm 'e! *%!%oE8:&ran#ecc%2n a meno# 'e 8 cm 'e! *%!%oE9:&ran#ecc%2n a n%$e! 'e! *%!%oE4:#earac%2n 'e CH? y CHIE:: &%o C V !e#%2n 'e! H%!%oAtrs&er). An analisis of the problem in biliary injury during laparoscopic cholecystectomy. < .m Coll Aur) 2001B 1G00 101-1254 e#&a'o# (a#a'o en e! mecan%#mo 'e !e#%2n:CLASIDICACI>N ?E STEUART UAWT%oI:%nc%#%2no&ran#ecc%2n %ncom!e&a 'e! co!3'oco.T%oII:'aSo!a&era!a!con'uc&o *e/&%co comIn or cau&er%o o c!%.T%oIII:&ran#ecc%2ncom!e&a'e! co!3'oco o *e/&%co comIn.T%oIV:'aSo'e!*e/&%co'er.o acce#or%o.Merc!o M.$ Domn)ueF I. Classification and management of bile duct injuries. ?oel! < @strointest Aur). 2013B3182083 - 8GTRATA6IENT> INICIAL ?IAGN>STIC>INTRA>PERAT>RI>> P>ST>PERAT>RI>IN6E?IAT>.E! &ra&am%en&o%n%c%a!'e(e%nc!u%re! con&ro!'e!",u%'o#y'e!e#&a'o nu&r%c%ona!4e!u#o'ean&%(%2&%co#y !aa!%cac%2n'e$%&am%naX#%e7%#&e coa)u!oa&"a or 'eGc%enc%a.Merc!o M.$ Domn)ueF I. Classification and management of bile duct injuries. ?oel! < @strointest Aur). 2013B3182083 - 8GTRATA6IENT>C.IRYRGIC>S1. Rearac%2n &erm%no ; &erm%na!.8. Hea&oyeyunoana#&omo#%#.9. P!a#&%a 'e !a e#&eno#%# &%o He%neRe-6%Ru!%c+.4. Con#&rucc%2n 'e !a (%furcac%2n (%!%ar.:. Proce'%m%en&o 'e Lon)m%re.Z. Hea&%co'uo'eno#&om"aMerc!o M.$ Domn)ueF I. Classification and management of bile duct injuries. ?oel! < @strointest Aur). 2013B3182083 - 8GREPARACI>N TRANSC.IR.RGICA6enor mor(%!%'a' y mor&a!%'a'.Te0%'o norma!.Buena con'%c%2n G#%o!2)%ca.Po#%(%!%'a' 'e un #o!o roce'%m%en&o.Le#%one# !a&era!e#: #u&ura '%rec&a #o(re &u(o 'e Xe*r4 or 9 a 4 #emana#.Aur) Clin 3 .M 200GB GG0 1329-1383REPARACI>N TRANSC.IR.RGICA.En#ecc%one#arc%a!e#menore#a1=NMSTIC>La mor(%!%'a' o#& oera&or%a 'e una rearac%2n (%!%ar e# a!&aCom!%cac%one# *a#&a en un 9