Fully 90% of all strictures affecting the larger bile ducts are man-made. It is the surgeon and his traumatizing procedures which prepare the soil for these cicatricial obstructions. In addition to patients who live with these chronic strictures, there are many who die from bile peritonitis, internal biliary fistulas, subhepatic abscesses, and liver necrosis because of the accidental ligation or division of the major hepatic bile ducts or blood vessels.
It is most difficult to determine the true incidence of such accidents because surgeons hesitate to admit their errors for fear of legal reprisals. A review of the records of five major hospitals in Salt Lake City, from 1952 to 1957, revealed 3,728 operations on the extrahepatic biliary system, of which 97, or 2.8%, were for strictures of the bile ducts. In only 44 instances, however, did the final diagnosis indicate that surgical trauma was the etiological factor, and in
HICKEN NF, McALLISTER AJ. Accidental Trauma to the Bile Ducts: Causes and Prevention. AMA Arch Surg. 1959;78(1):1–6. doi:10.1001/archsurg.1959.04320010005001
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