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.

The post Subvesical Duct Detected by Magnetic Resonance Cholangiopancreatography (MRCP) in a Patient with Bile Leak after Laparoscopic Cholecystectomy first appeared on JSLS.

Department of General Surgery, Horizon Health Paris Clinic, Paris, IL (Dr Li), Department of General Surgery, Cleveland Clinic Florida, Weston, FL (Drs Lo Menzo, Szomstein, and Rosenthal)

ABSTRACT

Introduction: Gallbladder volvulus is rare, but delay in diagnosis and surgical intervention can lead to significant morbidity and mortality.

Case Description: An older woman presented with abdominal pain and was diagnosed with acute cholecystitis. During surgery, she was found to have 360-degree counterclockwise torsion of the gallbladder with ischemia. Laparoscopic cholecystectomy was performed without complications.

Conclusion: In the proper clinical setting, there is no need to explore extra studies for a preoperative confirmatory diagnosis, which may delay surgical intervention. Good prognosis is expected after prompt cholecystectomy.

Key Words: Gallbladder volvulus, Abdominal pain, Acute cholecystitis, Laparoscopic cholecystectomy.

The post Gallbladder Volvulus: Case Report and Review of the Literature first appeared on JSLS.

Department of Surgery, Kansai Medical University (all authors).

ABSTRACT

Introduction: Bile duct injury is a serious and life-threatening problem. This well-known, albeit rare, problem is an important complication of laparoscopic cholecystectomy.

Case Description: A 74-year-old woman was referred to our surgical department for elective cholecystectomy due to gallstone disease. We proceeded with elective laparoscopic cholecystectomy as planned. Dissection near Calot’s triangle was initiated to obtain the critical view of safety. The dissection gradually revealed a thin, bile duct–like structure adhered to the gallbladder surface. The bile duct–like structure was finally revealed to be the common hepatic duct, which had been pulled from its normal position and was stuck to the gallbladder body. Until this point in the operation, the common hepatic duct had been mistaken for the cystic duct and was almost divided. The true Calot’s triangle was then recognized and dissected. The true cystic duct and cystic artery were then identified. The common hepatic duct was firmly adhered to the gallbladder body and was difficult to release from the gallbladder wall. Therefore, subtotal cholecystectomy was completed.

Conclusions: Careful intraoperative observation of Calot’s triangle is important to prevent bile duct injury. If surgeons find it difficult to identify the location of this triangle, they should perform subtotal cholecystectomy to prevent intraoperative complications.

Key Words: Bile duct injury, Calot’s triangle, critical view of safety, laparoscopic cholecystectomy, subtotal cholecystectomy.

The post Near-Miss Hepatic Duct Injury Resulting From Misidentification of Calot’s Triangle During Laparoscopic Cholecystectomy first appeared on JSLS.

Department of General Surgery, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand (both authors).

ABSTRACT

Introduction: Gallbladder torsion is uncommon and difficult to diagnose before surgery.

Case Description: We present a case of gallbladder torsion and review the literature on etiology, clinical presentation, radiological diagnosis, and intraoperative pitfalls.

Conclusion: A high index of suspicion for this rare entity and early surgical intervention are key in reducing mortality and preventing operative complications.

Key Words: Gallbladder, Laparoscopic cholecystectomy, Torsion abnormality.

The post Gallbladder Torsion first appeared on JSLS.

The post Laparoscopic Cholecystectomy in Patients with Situs Inversus Totalis first appeared on JSLS.

Department of General, Thoracic and Vascular Surgery, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden, Germany (Drs. Wolk, Weitz, and Distler). Institute for Diagnostic Radiology, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden, Dresden, Germany (Dr. Plodeck).

ABSTRACT

Portomesenteric venous thrombosis is a rare complication after laparoscopic cholecystectomy. Sufficient management is important for prevention of bowel infarction. We present a severe case of portomesenteric venous thrombosis. Partial thrombosis of the central portal vein, complete thrombosis of the left portal vein and the superior mesenteric vein, as well as venous stasis of the small bowel and the ascending and transverse colon were seen on computed tomography angiography. After surgical thrombectomy and catheter-directed venous thrombolysis, the patient developed rethrombosis of the superior mesenteric vein with an additional thrombosis of the right liver artery. Relaparotomy and a further thrombectomy were performed. Bowel infarction was prevented, and on postoperative day 19, the patient was discharged in good condition. In this case of severe portomesenteric venous thrombosis, we found no thrombophilic disorders and 6 months of anticoagulation were recommended.

Key Words: Laparoscopic cholecystectomy, Portomesenteric venous thrombosis, Risk factors.

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The post Severe Mesenteric Venous Thrombosis After Laparoscopic Cholecystectomy first appeared on JSLS.