Conservative Management of Bile Leak Secondary to an Accessory Duct of Luschka

Abstract

Introduction: Post cholecystectomy bile leaks are rare, have an incidence of 0.1-1%, and regardless of their nature, most cannot be detected during surgery. In 5-30% they correspond to a Luschka duct, which are small ducts that originate in the right hepatic lobe, extend to the gallbladder bed and may or may not drain to the extrahepatic bile ducts. The objective of this publication is to present the experience obtained in the minimally invasive and conservative management of a post-laparoscopic cholecystectomy bilioma due to leakage of the luschka duct. Case: Female patient of 59 years, with Diagnosis : Multiple Myeloma + Cholelithiasis, undergoing laparoscopic cholecystectomy. Two days after surgety, a subphrenic collection is identified, which is drained percutaneously, with ultrasound guidance, and bilious fluid is obtained, approximately 800 cc. Subsequently, in the collagioresonance a bile duct lesion is identified, which is born from the right posterior bile duct and is directed towards the hepatic bed, with indemnity of the main bile duct. The debit decreases progressively during the first week, presenting a negative debit 15 days after placement and the catheter is removed one week later. The evolution 1 month later is favorable, with normal ultrasound controls. Conclusion: The minimally invasive treatment of bile leakage can be considered a safe option in patients with minor injuries, in order to avoid exposure to invasive procedures such as endoscopic retrograde cholangiography and its possible complications.