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Management Of Bile Leak From Luschka Ducts After Laparoscopic Cholecystectomy: An Original Procedure For Coil Embolization

G. Salsano, F. Paparo, A. Valdata, Lorenzo Patrone, M. Filauro, G. Rollandi, G. D. Caro
Published 2015 · Medicine

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Dear Sirs, Gallstone disease is one of the most common affections of the digestive system in Western societies, and laparoscopic cholecystectomy is the treatment of choice [1]. Postoperative biliary leaks remain a significant cause of morbidity in patients undergoing this procedure, occurring in 0.2–2 % of cases [2]. The cystic duct stump is the most common site of bile leakage (94.5 % of cases), followed by Luschka ducts in the remaining (5.5 % of cases) [3]. The diagnosis of iatrogenic section of Luschka ducts (prevalence of 4 % in general population) always has to be taken into account in the occurrence of post-cholecystectomy bile leaks [4]. If not properly managed, the persistent leakage of bile will lead to subhepatic bile collections, biliary peritonitis, and subphrenic/subhepatic abscesses. The present report describes a novel percutaneous interventional procedure to manage a persistent bile leak from an injured Luschka duct. A subject, 67-year-old man, was admitted to the emergency department of our hospital owing to abdominal pain and obstructive jaundice. Contrast-enhanced computed tomography (CT) of the abdomen showed swelling and enlargement of the gallbladder with diffuse wall thickening and increased attenuation of the connective fat tissue of the gallbladder fossa. Significant dilatation of the intraand extrahepatic bile ducts was also appreciable. There was no evidence of radio-opaque cholelithiasis on CT-images. Preoperative MRCP confirmed the dilatation of intraand extrahepatic bile ducts and showed the presence of two gallstones: in the distal common bile duct and in the gallbladder infundibulum. In addition, the MRCP showed a fine network of small biliary ductules adjacent to the gallbladder fossa and to the superior wall of the gallbladder neck (Fig. 1). However, this MRCP finding was neither recognized nor specified in the radiological report. The patient underwent laparoscopic cholecystectomy; intraoperative Endoscopic Retrograde Cholangio-pancreatography (ERCP) with sphincterotomy was also performed and the smaller gallstone was removed. Five days after discharge, the patient presented with fever, abdominal pain, and vomiting. Abdominal ultrasound showed a subhepatic fluid collection, which was confirmed to be a biloma in the & Giancarlo Salsano giancarlo.salsano@yahoo.it
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