The retrospective documentation of legal cases with bile duct injury that were submitted for consideration to İstanbul Forensic Medicine Institute by the courts between 2008-2012.
OBJECTIVE
The aim was to evaluate the parameters that were considered by Forensic Medicine in bile duct injury as well as the issues that the physicians were found to be faulty.


METHODS
The following parameters were investigated in 21 files that were referred to Istanbul Forensic Medicine Institute with request of expert opinion between 2008-2012; expert decisions, patient's age, gender, written patient consent, diagnosis, type of first surgery, surgical complications, timing of complication diagnosis within the scope of complication management, patient's referral timing, troubleshooting procedures and mortality rate.


RESULTS
Physicians were found to be faulty in all files. The reason for physician fault was failure to show the necessary professional care and attention in one (4.7%) file, late recognition of injury and late transfer of the patient in 20 (95.3%) files. Written consent had not been obtained in any of the files. Thirteen patients were female (61.9%) and 8 (30.1%) were male, with a mean age of 43.3 years. Nineteen patients had cholelithiasis (90.4%), and two patients (9.5%) had a mass in the head of the pancreas. Cholecystectomy was performed laparoscopically in 15 patients (78.9%), and with open surgery in 4 patients (21.1%). The Whipple procedure was performed in two patients. The diagnosis was made during the operation in one patient (4.7%), and in the post-operative period in 20 patients (95.3%). The time to diagnosis after surgery was between 3-6 days. All of the patients had been referred to third level health care facilities. The timing of transfer was 1 day in the patient who was diagnosed during the operation, and ranged between 4-10 days in those who were diagnosed postoperatively. Reasons for late referral were delays related to pending test results in 12 patients, vague signs in 3 patients, and following-up patients with the thought that the biliary fistula will heal by itself in 5 patients. Mortality was not observed in any of the examined files.


CONCLUSIONS
The issues where physicians were most frequently found to be faulty were failure to obtain written patient consent, late recognition of injury and late transfer of the patient.
Department of General Surgery, Forensic Medicine Institute, İstanbul, Turkey.
M Arif
MA
Karakaya
Clinic of Gastroenterology Surgery, Diyarbakır Training and Research Hospital, Diyarbakır, Turkey.
Okay
O
Koç
Department of General Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey.
Feza
F
Ekiz
Clinic of General Surgery, Kartal Dr. Lütfi Kırdar Training and Research Hospital, İstanbul, Turkey.
A Feran
AF
Ağaçhan
Biliary injury; complication; malpractice