Minimal invasive treatment of biliary leak after laparoscopic cholecystectomy

Abstract

The laparoscopic cholecystectomy has become one of the most common operations for treatment of symptomatic gallbladder disease. However significant postoperative biliary duct injuries can occur, leading to biliary leaks. Here we present a case where multiple abdominal collections are detected in a 64-year-old male patient who underwent laparoscopic cholecystectomy due to gallbladder stones two weeks prior. Percutaneous drainage under computed tomography guidance is implemented to treat the collections which result to be bilomas. After controlling the leak, an endoscopic retrograde cholangiopancreatography with papillotomy and stent placement is performed believing that the problem was settled in the cystic duct. But after observing that the leak increased with this treatment, an anatomical variation is suspected. A percutaneous transhepatic cholangiography is performed which confirm the diagnosis. In case of any deviation of a normal surgical post operatory, a biliary leak must be suspected. Surgeons nowadays must be trained in different diagnosis and treatment methods.

Keywords

• Bile ducts
• Biliary fistula
• Cholangiography
• Cystic duct
• Radiology
• interventional