Diagnosis, management and prevention of iatrogenic injury in choledocho-pancreatico-duodenal junction        WEI Jun-min. Department of General Surgery,Beijing Hospital, Beijing 100730,China
Abstract    Iatrogenic injury of choledocho-pancreatico-duodenaljunction refers to the penetrating injury in the terminal bile duct，pancreatic duct or duodenal wall in the region of ampulla of Vater．It is often caused by improper operation of surgical instruments.It results in severe peritonealand retroperitoneal space infection and a poor prognosis．The early manifestations of bile duct perforation include peritoneal swelling caused by detained water after trans T-tube injection，blue staining of the field of operation and contrast medium leaking outside the bile duct system.If the perforation is discovered during the operation，it should be sutured and choledocal T-tube drainage should be performed．If the perforation is not discovered during the operation，choledocal T-tube and peritoneal drainage should be conducted．For patients with delayed diagnosis，thorough drainage of the region，separation of bile and pancreatic juice，duodenal diverticularization and jejunostomy should be considered．The key point in preventing the injury lies on full knowledge of the anatomy of the region，delicate practice without forceful exploration and detailed examination after the operation to avoid missing diagnosis．