**5.1 Laboratory diagnosis**

Laboratory tests and imaging are used in IBDI diagnostics. In the laboratory tests, cholestasis and liver function indicators, such as bilirubin, alkaline phosphatase (FA), gamma-glutamyl-transpeptidase (GGT), alanine transaminase (ALT) and aspartate transaminase (AST), are the most useful. In patients with biliary stenosis cholestasis parameters are increased: serum bilirubin, FA, GGT and 5'-nucleotidase and leucine aminoptidase (LAP) (less marked in the laboratory), and transaminase values usually remain normal (the liver is not damaged). Elevated transaminase levels indicate damage to liver parenchyma and the development of secondary biliary cirrhosis hypoalbuminemia and prolonged prothrombin time occur due to damaged liver synthetic function.

#### **5.2 Radiological diagnosis**

In IBDI diagnostics, imaging ultrasound (USG), abdominal computed tomography (CT) scan of the abdominal cavity, percutaneous cholangiography, endoscopic cholangiography and magnetic resonance imaging are performed. Abdominal ultrasound allows the visualization of intra-and extrahepatic bile ducts with the measurement of width and visibility of the

There are many factors that increase the IBDI risk during surgery. Coexisting chronic or exacerbated inflammation of the operated area, obese patient, the presence of abundant adipose tissue around the hepatoduodenal ligament, not sufficiently broad insight into the operative field, and bleeding increases the difficulty of surgery and promote bile duct injuries. The conditions in which laparoscopic cholecystectomy is performed, also affect the rate of IBDI formation. Adverse factors include older age, male gender and long duration of symptoms prior to surgery. Biliary anomalies and variability of the arteries are also the factors associated with increased IBDI risk. Unusually reputed hepatic duct may be mistakenly regarded as the cystic duct and ligated or cut. Excessive, more than is necessary, dissection around the hepatoduodenal ligament during cholecystectomy may lead to damage to the axial arteries running along the CBD. Vascular damage is the cause of postoperative biliary strictures due to ischemia . According to the literature, during the distal bile duct injury the axial artery damage usually occurs (incidence 10-15% of cases), while during high biliary injuries of the proximal bile duct damage to the branches of the

The most frequently observed clinical symptoms include jaundice, fever, chills, abdominal pain, pruritus. Clinical symptoms can be divided into two main groups. The first group are patients with the bile leakage in the early postoperative period due to the bile duct injury. In the presence of a drain in the peritoneal cavity, the injury indicates the appearance of bile in the drain. In patients without a catheter in the peritoneal cavity, bile leak into the abdominal cavity, leading to biloma or bile peritonitis. In these patients, jaundice is not observed because there is no cholestasis. In the second group of patients, usually in a remote time after surgery, there are primarily clinical symptoms resulting from cholestasis due to biliary

Laboratory tests and imaging are used in IBDI diagnostics. In the laboratory tests, cholestasis and liver function indicators, such as bilirubin, alkaline phosphatase (FA), gamma-glutamyl-transpeptidase (GGT), alanine transaminase (ALT) and aspartate transaminase (AST), are the most useful. In patients with biliary stenosis cholestasis parameters are increased: serum bilirubin, FA, GGT and 5'-nucleotidase and leucine aminoptidase (LAP) (less marked in the laboratory), and transaminase values usually remain normal (the liver is not damaged). Elevated transaminase levels indicate damage to liver parenchyma and the development of secondary biliary cirrhosis hypoalbuminemia and

In IBDI diagnostics, imaging ultrasound (USG), abdominal computed tomography (CT) scan of the abdominal cavity, percutaneous cholangiography, endoscopic cholangiography and magnetic resonance imaging are performed. Abdominal ultrasound allows the visualization of intra-and extrahepatic bile ducts with the measurement of width and visibility of the

prolonged prothrombin time occur due to damaged liver synthetic function.

proper hepatic artery occurs (incidence 40-60% of cases).

obstruction. This is most commonly jaundice,

**5.1 Laboratory diagnosis** 

**5.2 Radiological diagnosis** 

**5. Diagnosis of iatrogenic bile duct injuries** 

**4. Clinical presentation of iatrogenic bile duct injuries** 

biloma within the peritoneal cavity in the case of bile leakage. In doubtful cases, you can perform abdominal CT to accurately depict the reservoir of bile. Accurate assessment of biliary tree can be made using cholangiography. Percutaneous cholangiography (percutaneous transhepatic cholangiography, PTC) is useful to evaluate the bile ducts proximal to the injury. Endoscopic cholangiography (endoscopic retrograde cholangiopancreatography, ERCP) plays a very important role in the imaging of biliary tract injuries. During ERCP it is possible to supply minor injuries through the establishment of the prosthesis into the lumen of the damaged bile ducts. The advantage of magnetic resonance cholangiography (cholangio-MR) imaging is the high accuracy of the biliary tree and it is non-invasive. This investigation is primarily used to assess the biliary tract before the reconstructive surgery.
