Department of Clinical Education, Taipei Tzu Chi Hospital, Buddhist Tzu, Chi Medical Foundation, New Taipei, Taiwan (Dr. Y-H Lin)
Department of Radiology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi, Medical Foundation, Chiayi, Taiwan (Dr. C-W Lin)
Department of Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan (Dr. W-Y Yin) School of Medicine, Tzu Chi University, Hualien, Taiwan (Drs. Y-H Lin, C-W Lin, and W-Y Yin)

ABSTRACT

We report a case of bile leaks post-laparoscopic cholecystectomy (LC) with initial treatment failure by common bile duct stent insertion. The injury of a subvesical duct running from gallbladder fossa toward an area of fluid accumulation that was not revealed by computed tomography and endoscopic retrograde cholangiopancreatography previously, was even- tually found by magnetic resonance cholangiopancreatography (MRCP) and proved to be the cause of bile leak. Also, several tiny branches in the right liver instead of a main trunk and another subvesical duct draining into the common bile hepatic duct was noted. These anatomic variations were scarcely reported, especially by MRCP.
The aim of this case report is to discuss the link between biliary tree anomaly and bile leak due to bile duct injury during LC in our experience treating one patient. Also, we review related literature to understand more on prevention or man- agement of subvesical duct injury.

Key Words: Subvesical duct injury, Laparoscopic cholecystectomy, Bile leak, Biliary tree anomaly.

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Department of Surgery, (Drs. Faraj, Malek, Itani, Mr. El Naaj, Ms. El Nouno, Dr. Khalife), Department of Radiology, (Drs. El Merhi, Haidar), American University of Beirut Medical Center, Beirut, Lebanon.

ABSTRACT

Introduction: The liver is the organ most commonly affected by hydatid disease and is involved in up to 70% of cases. Surgical management can be open or laparoscopic; it can vary from a radical procedure such as hepatic resection or pericystectomy or a more conservative approach such as partial cystectomy. Bile leak after surgery can occur in between 13% and 26% of cases.

Case Description: We present the case of a 47-year-old patient who was diagnosed with 2 large hydatid liver cysts in segments V and VI and segments II and III, respectively. She underwent laparoscopic pericystectomy for both cysts and was discharged 2 days later. She presented after 10 days complaining of abdominal pain and fever. Computed tomography scan of the abdomen showed a 6 7–cm collection at the surgical site of segments II and III. A percutaneous drain was inserted and drained 60 mL of dark bilious fluid. The patient did well after drainage and was discharged home after 6 days.

Discussion: Irrespective of the surgical treatment chosen, bile leaks may complicate any procedure and must always be considered seriously. Although there have been numerous studies concerning bile leak after open surgery, there are only a few describing bile leaks after laparoscopic surgery. Managing bile leaks after hydatid cyst excision is still a matter of debate. Some physicians would advocate conservative management; other physicians would recommend a further procedure such as sphincterotomy or biliary stenting after endoscopic retrograde cholangiopancreatography.

Key Words: Hydatid disease, Open surgery, Laparoscopic surgery, Bile leak.

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