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A rare case of biliary leakage after laparoscopic cholecystectomy-diagnostic evaluation and nonsurgical treatment: a case report.

Mehmedovic Z, Mehmedovic M, Hasanovic J - Acta Inform Med (2015)

Bottom Line: Results of conducted diagnostics verify the presence of biliary fistula caused by obstruction of bile pathways by stagnant pus and microcalculi of common bile duct, with development of biloma presumably caused by pressure injection of contrast material during ERCP procedure.Endoscopic sphincterectomy via ERCP enabled healing of formed biliary fistula, whilst continuous percutaneous ultrasound guided drainage of biloma was method of choice in later treatment of our patient.It is important to note that diagnostic evaluation of biliary fistula is very challenging and that timely nonsurgical treatment is of great benefit for patient.

View Article: PubMed Central - PubMed

Affiliation: Department of General Abdominal Surgery, Clinic for Surgery, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina.

ABSTRACT
Although laparoscopic cholecystectomy has become a gold standard in treatment of symptomatic cholelithiasis, it is associated with higher risk of intraoperative lesions and primarily lesions of biliary ducts. In small percentage of cases biliary fistulas occur, most commonly after leakage from cystic duct stump or accessory bile ducts - Luschka's duct. We report of a patient who had episodes of abdominal pain following routine laparoscopic cholecystectomy for acute calculous gallbladder. Results of conducted diagnostics verify the presence of biliary fistula caused by obstruction of bile pathways by stagnant pus and microcalculi of common bile duct, with development of biloma presumably caused by pressure injection of contrast material during ERCP procedure. Endoscopic sphincterectomy via ERCP enabled healing of formed biliary fistula, whilst continuous percutaneous ultrasound guided drainage of biloma was method of choice in later treatment of our patient. It is important to note that diagnostic evaluation of biliary fistula is very challenging and that timely nonsurgical treatment is of great benefit for patient.

No MeSH data available.


Related in: MedlinePlus

Postoperative/post-inflammatory changes of extrahepatic bile ducts, whilst bile ducts are not dilatated. Both right and left hepatic ducts as well as common hepatic duct are seen. Lamellar forms of free fluid are seen in perihepatic and subhepatic region (MR).
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Figure 1: Postoperative/post-inflammatory changes of extrahepatic bile ducts, whilst bile ducts are not dilatated. Both right and left hepatic ducts as well as common hepatic duct are seen. Lamellar forms of free fluid are seen in perihepatic and subhepatic region (MR).

Mentions: Furthermore magnetic resonance cholangiopancreatography (MRCP) was performed which concluded of postoperative/post-inflammatory changes of extrahepatic bile ducts with no significant dilatation, but with dense bile and punctiform calculi intraluminally. MRCP also described lamellar forms of free abdominal fluid in region of removed gallbladder bed [Figures 1, 2, 3]. Gastroenterologist was consulted and endoscopic ultrasound (EUS) was performed which concluded of microcholedocholithiasis, cholangitis and possible interstitial pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) was performed; after injection of contrast microcalculosis of common bile duct and detritus of pus intraluminally were identified [Figure 4]. Sphincterectomy was performed during endoscopic intervention. After ERCP elevation of values of pancreatic amylases and lipases in a sense of post-ERCP pancreatitis was seen in laboratory findings of patient (serum amylases= 317 U/L; urine amylases=3764 U/L; lipase=2129 U/L).


A rare case of biliary leakage after laparoscopic cholecystectomy-diagnostic evaluation and nonsurgical treatment: a case report.

Mehmedovic Z, Mehmedovic M, Hasanovic J - Acta Inform Med (2015)

Postoperative/post-inflammatory changes of extrahepatic bile ducts, whilst bile ducts are not dilatated. Both right and left hepatic ducts as well as common hepatic duct are seen. Lamellar forms of free fluid are seen in perihepatic and subhepatic region (MR).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4430001&req=5

Figure 1: Postoperative/post-inflammatory changes of extrahepatic bile ducts, whilst bile ducts are not dilatated. Both right and left hepatic ducts as well as common hepatic duct are seen. Lamellar forms of free fluid are seen in perihepatic and subhepatic region (MR).
Mentions: Furthermore magnetic resonance cholangiopancreatography (MRCP) was performed which concluded of postoperative/post-inflammatory changes of extrahepatic bile ducts with no significant dilatation, but with dense bile and punctiform calculi intraluminally. MRCP also described lamellar forms of free abdominal fluid in region of removed gallbladder bed [Figures 1, 2, 3]. Gastroenterologist was consulted and endoscopic ultrasound (EUS) was performed which concluded of microcholedocholithiasis, cholangitis and possible interstitial pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) was performed; after injection of contrast microcalculosis of common bile duct and detritus of pus intraluminally were identified [Figure 4]. Sphincterectomy was performed during endoscopic intervention. After ERCP elevation of values of pancreatic amylases and lipases in a sense of post-ERCP pancreatitis was seen in laboratory findings of patient (serum amylases= 317 U/L; urine amylases=3764 U/L; lipase=2129 U/L).

Bottom Line: Results of conducted diagnostics verify the presence of biliary fistula caused by obstruction of bile pathways by stagnant pus and microcalculi of common bile duct, with development of biloma presumably caused by pressure injection of contrast material during ERCP procedure.Endoscopic sphincterectomy via ERCP enabled healing of formed biliary fistula, whilst continuous percutaneous ultrasound guided drainage of biloma was method of choice in later treatment of our patient.It is important to note that diagnostic evaluation of biliary fistula is very challenging and that timely nonsurgical treatment is of great benefit for patient.

View Article: PubMed Central - PubMed

Affiliation: Department of General Abdominal Surgery, Clinic for Surgery, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina.

ABSTRACT
Although laparoscopic cholecystectomy has become a gold standard in treatment of symptomatic cholelithiasis, it is associated with higher risk of intraoperative lesions and primarily lesions of biliary ducts. In small percentage of cases biliary fistulas occur, most commonly after leakage from cystic duct stump or accessory bile ducts - Luschka's duct. We report of a patient who had episodes of abdominal pain following routine laparoscopic cholecystectomy for acute calculous gallbladder. Results of conducted diagnostics verify the presence of biliary fistula caused by obstruction of bile pathways by stagnant pus and microcalculi of common bile duct, with development of biloma presumably caused by pressure injection of contrast material during ERCP procedure. Endoscopic sphincterectomy via ERCP enabled healing of formed biliary fistula, whilst continuous percutaneous ultrasound guided drainage of biloma was method of choice in later treatment of our patient. It is important to note that diagnostic evaluation of biliary fistula is very challenging and that timely nonsurgical treatment is of great benefit for patient.

No MeSH data available.


Related in: MedlinePlus