Tertiary Referral (CBD Injury)

Doctor Instruction:

Mrs Smith, a 52-year-old lady, underwent laparoscopic cholecystectomy. Post-operative day 4, the operation was uneventful - 2 clips were applied to the common bile duct and 2 clips were applied to the cystic artery. Since yesterday, Mrs Smith complained of worsening generalised abdominal pain. Ultrasound showed free fluid in the abdomen with no common bile duct dilatation. She has tachycardia, jaundice and pyrexia. Today there is bile in the abdominal drain. Most recent blood tests were taken yesterday which showed: WBC 18, CRP 50, and raised bilirubin.

Currently, the hospital's ERCP services are closed due to staff shortages. Your consultant thinks there is bile leakage from CBD injury and wants you to transfer the patient to the HPB consultant Professor Adam Jones at a tertiary centre. Your consultant is currently away in a meeting.

Please refer this patient over the telephone and talk to the surgical registrar under Professor Adam Jones for a possible CBD injury.

Questions from Registrar:

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