Abstract
Complications related to cholecystectomy are well described. Most occur in the early postoperative period and are recognised either at the time of, or shortly after surgery. Clinical sequelae occurring years following cholecystectomy are rare and infrequently reported. In addition, most delayed complications are related to the continuing presence or new formation of gallstones. In this paper we present a unique case of an abscess of the common bile duct wall, presenting with painless obstructive jaundice more than 30 years following an open cholecystectomy, without the presence of gallstones. The clinical presentation, investigations, and treatment are discussed with a review of other relevant reported cases in the literature.
Highlights
Reported complications of cholecystectomy include damage to the common bile duct [1], bile leaks from the gallbladder bed or cystic duct stump [2], dropped gallstones [3], and damage to other structures such as the small bowel, liver, or diaphragm [4]
The complications of laparoscopic surgery have lessened with growing technical expertise, and laparoscopic cholecystectomy is considered the gold standard [5]
The possibility of iatrogenic injury at the time of endoscopic retrograde cholangiopancreatography (ERCP) is unlikely because the procedure was technically simple and the images at the time of the ERCP demonstrate the presence of the obstructing lesion clearly
Summary
Reported complications of cholecystectomy include damage to the common bile duct [1], bile leaks from the gallbladder bed or cystic duct stump [2], dropped gallstones [3], and damage to other structures such as the small bowel, liver, or diaphragm [4]. The complications of laparoscopic surgery have lessened with growing technical expertise, and laparoscopic cholecystectomy is considered the gold standard [5]. The essential steps of a cholecystectomy remain the same. These steps include adequate visualisation of the structures to obtain “the critical view,” secure occlusion of the cystic duct and artery, good haemostasis, and the treatment of any bile leaks from the gallbladder bed, or bile or stone spillages from an iatrogenically perforated gallbladder. Inadequate performance of any of these steps can lead to complications many years following the initial operation, as presented in this paper, and as such attention to operative detail is of paramount importance
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