An Unusual Bile Collection After Postcholecystectomy Bile Leakage

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Leakage from the cystic duct stumps accounts for the majority of postlaparoscopic cholecystectomy leaks. It commonly presents with a localized bile collection in the gallbladder fossa and endoscopic retrograde cholangiopancreatography (ERCP) with biliary stenting is a common method of treatment. However, bile may collect in other intra-abdominal locations away from the gallbladder fossa. We present here a case of a patient who developed upper abdominal pain with distension, anorexia, and vomiting a week after laparoscopic cholecystectomy. Ultrasonography and computed tomography scans showed an intra-abdominal collection and ERCP showed a cystic duct stump leak. A biliary stent was inserted and the collection was percutaneously drained. His symptoms, however, recurred 2 weeks later, with fever, anorexia, and weight loss. Abdominal computed tomography scan showed 9.3×8.5 cm cystic mass in the left hypochondriac area and ERCP showed persistent leakage from the cystic duct stump. The stent was changed to a larger size Fr12 and the collection was again drained percutaneously. His clinical condition improved dramatically. The biliary stent was removed after 8 weeks and remained well at 9-month follow-up.

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