Descending duodenal obstruction - a rare complication of laparoscopic cholecystectomy

We report a very rare case of descending duodenal obstruction in an elderly female developing following difficult laparoscopic cholecystectomy (LC). The patient presented with epigastric fullness and recurrent bilious vomiting for the last 5 years that started 2-3 months following LC. Although the site of the obstruction was localized to descending duodenum on the basis of pre-operative investigations, but the cause of obstruction could not be determined preoperatively. Exploration revealed peri-duodenal adhesions and narrowing of the descending duodenum as a cause of obstruction that were managed with duodenal kocherisation and duodenorrhaphy. The duodenal mucosa, on opening the duodenum at the site of narrowing, appeared normal and full thickness duodenal wall biopsy revealed no pathological lesion. Based on these findings and previous records, it became apparent that the duodenal obstruction occurred due to occult thermal damage caused by monopolar electro-cautery used for the dissection of the frozen Calot’s triangle during LC. The patient recovered well following surgery. This unusual case highlights that duodenal obstruction developing after LC should be considered as a possible delayed iatrogenic complication of direct contact burn or energy conduction burn caused by electro-cautery.