title: Common bile duct injury by fibrin glue: report of a rare complication.
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.
authors.affiliation: 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.
authors.forename: Yu-Long
authors.initials: YL
authors.lastname: Yang
authors.affiliation: 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.
authors.forename: Cheng
authors.initials: C
authors.lastname: Zhang
authors.affiliation: 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.
authors.forename: Hong-Wei
authors.initials: HW
authors.lastname: Zhang
authors.affiliation: 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.
authors.forename: Ping
authors.initials: P
authors.lastname: Wu
authors.affiliation: 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.
authors.forename: Yue-Feng
authors.initials: YF
authors.lastname: Ma
authors.affiliation: 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.
authors.forename: Mei-Ju
authors.initials: MJ
authors.lastname: Lin
authors.affiliation: 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.
authors.forename: Li-Jun
authors.initials: LJ
authors.lastname: Shi
authors.affiliation: 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.
authors.forename: Jing-Yi
authors.initials: JY
authors.lastname: Li
authors.affiliation: 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.
authors.forename: Mu
authors.initials: M
authors.lastname: Zhao
mesh_terms: D000368:Aged; D001706:Biopsy; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D049448:Cholangiopancreatography, Magnetic Resonance; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D003135:Common Bile Duct / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D015718:Fibrin Tissue Adhesive / Q000009:adverse effects*; D005549:Foreign-Body Reaction / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006488:Hemostasis, Surgical / Q000009:adverse effects*; D006801:Humans; D041781:Jaundice, Obstructive / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D008297:Male; D011237:Predictive Value of Tests; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D015718:Fibrin Tissue Adhesive
keywords: Bile duct injury; Choledocholithiasis; Choledochoscope; Fibrin glue; Laparoscopic cholecystectomy; Liver round ligament; Obstructive jaundice