Kasai Procedure for Treatment a Sever iatrogenic trauma to common hepatic duct in tumor resection surgery

Introduction:Iatrogenic bile duct injuries (IBDI) remain an important problem in gastrointestinal surgery. The early and accurate diagnosis of IBDI is very important for surgeons and gastroenterologists, because unrecognized IBDI lead to serious complications such as biliary cirrhosis, hepatic failure and death. Case Presentation:A 2-month old baby was brought to our center with progressive jaundice after a tumor resection surgery. MRCP revealed complete obstruction of proximal common hepatic duct. In HAIDA scan no secretion was detected.At the time of operation all common hepatic duct and common bile duct was resected. Therefore, Kasai procedure was done. Bilirubin and liver function test became normal gradually after surgery and patient is fine in 6 months follow up after surgery.Discussion:Iatrogenic injuries may be identified during the intervention, immediately afterwards, or have a delayed presentation. Endoscopic techniques such as stent placement are the primary form of management for pancreatic ductal injuries in patients with normal pancreatic anatomy.Bile duct injury, pancreatic injury, gallbladder injury and vascular injuries can be iatrogenic trauma in retroperitoneal or intraperitoneal resection of huge tumors in the sites near the liver. Prevention of these injuries by proper surgical technique and delineation of anatomy are important aspects. Conclusion:In huge tumors in retroperitoneal or intraperitoneal cavity with major vessels or vital organs involvement, it is advised to perform chemotherapy or radiotherapy or chemo-radiotherapy before surgery depending on pathologic diagnosis, even though sever and proximal iatrogenic or complete cutting of bile duct is happened, Kasai procedure can be the last and lifesaving procedure