Abstract
We describe a case of bile leakage following laparoscopic cholecystectomy further complicated by iatrogenic central bile duct obstruction. The site of leakage was identified not from the site of the inadvertent proper hepatic duct ligation but from a damaged aberrant subvesical duct communicating with the gallbladder fossa. The anatomy of these subvesical ducts is explained as is their surgical importance with relation to the aetiology of bile leaks after cholecystectomy.
Highlights
Bileleaks are recognised complications following cholecystectomy or other hepatobiliary surgery
A MR cholangiogram was attempted to try and show continuity between the right and left main hepatic bile ducts and the proper hepatic duct was shown to be occluded, no definite answer could be given concerning the existence of free communication between the right and left hepatic ducts or about the site of the bile leakage (Fig. 3)
These studies were followed by percutaneous transhepatic cholangiography (PTC)
Summary
A 3D-year-old woman presented 1 week after laparoscopic cholecystectomy with jaundice, upper abdominal pain and abdominal distension. A provisional diagnosis of bile duct injury was made. Abdominal ultrasonography showed fluid in the gallbladder fossa and subhepatic space (Fig. 1) and a large volume of free intraperitoneal fluid. The intrahepatic bile ducts were not dilated
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