Bismuth Classification of Bile Duct Injury and Its Association with Increasing 30 Days Mortality after Revision Surgery

Background: The incidence rate of bile duct injury has not been changed for many years for both open or laparoscopic technique.  Open cholecystectomy has risen from 0.5% to 1.4% when gallbladder removal is performed laparoscopically.  Injuries of the bile duct system after laparoscopic cholecystectomy are more complex than that after an open approach, causing significant morbidity and even death.  From initial classification published by Bismuth, there have been many classifications of common bile duct injury.  We would reported the 30 days mortality rate following reconstruction after bile duct injury according to type of Bismuth classification. Case Report: 7 cases of common bile duct injury were reported from 2016 until 2018 following cholecystectomy (both open and laparoscopic), all cases were diagnosed as early complication and without intra operative cholangiography performed.  The most common bile duct injury was Bismuth type II and IV (2 patients in each type).  Reconstruction has been done by hepatico jejunostomy for type III and IV.  Choledoco Duodenostomy bypass was done for type I and II.  2 patients with bismuth type IV have long standing cholangitis and cannot survive during 30 days of follow up.  4 others patients could survive with no intra abdominal complication nor other morbidity. Conclusion:  Bismuth  classification was the simpliest type to described the bile duct injury, Bismuth type IV was associated with the high risk of 30 days mortality rate.   Keywords: bismuth classification, bile duct injury, cholecystectomy, mortality

Abstract PO-080: Increasing of emergency presentation on colorectal cancer patients during COVID-19 pandemic: A retrospective study on single-center academic hospital

Background: Colorectal cancer was the most common cancer found in the GI tract; the two most common clinical emergency presentations were intestinal obstruction and perforation on the tumor site or proximally to the distal tumor. During the COVID-19 pandemic, we must face the new condition; we should modify the clinical outpatients’ schedule, which could address the other problem, that colorectal cancer patients refuse to continue treatment planning and that elective and well-prepared operations will be decreased.

Methods: We will report the clinical presentation of our colorectal cancer patients during the last 2 months from March until May 2020. All patients with emergency presentation of colorectal cancer will be included; any comorbidities will be recorded on this study. Patients with emergency colorectal cancer who could not fit for emergency operation will be excluded. Inpatient mortality and postoperative complications will be evaluated.

Results: During the 2-month period, we evaluated 26 cases of emergency colorectal cancer patients. Most of the patients came with total intestinal obstruction on the emergency presentation (22 cases); the others (4 cases) came with diffuse peritonitis due to colonic perforation. All patients were reported negative for COVID-19 on rapid test. Exploratory laparotomy was done in this emergency setting; 10 patients had sigmoid colon cancer, 15 patients had rectal cancer, and 6 patients had right colonic cancer. Intestinal perforation was found on rectal cancer patients. Tumor resection and primary anastomosis were done on 18 patients, and the others had stoma diversion. Inpatient mortality reported on 4 patients of perforation cases and had cardiopulmonary complication postoperatively.

Conclusion: During the COVID-19 pandemic, emergency presentation of colorectal patients increased, and intestinal perforation was the risk factor of inpatient mortality.

Citation Format: Budhi Ida Bagus, Metria Ida Bagus, Setyawati Ida Ayu, Mastini Ida Ayu Kade. Increasing of emergency presentation on colorectal cancer patients during COVID-19 pandemic: A retrospective study on single-center academic hospital [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-080.