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Special Feature |

Image of the Month—Quiz Case FREE

Samuel E. Bledsoe, MD; Kimball I. Maull, MD
[+] Author Affiliations

Section Editor: Bredenberg Carl E., MD


Arch Surg. 2008;143(11):1127. doi:10.1001/archsurg.143.11.1127.
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A 45-year-old woman presented to the emergency department with nausea, vomiting, and abdominal pain. Her medical history was significant for mental retardation, morbid obesity, hypertension, chronic renal insufficiency requiring dialysis, insulin-dependent diabetes mellitus, congestive heart failure, and hydrocephalus controlled by a ventriculoperitoneal shunt. Liver function test results were normal. An uneventful open cholecystectomy was performed for porcelain gallbladder. On the 10th postoperative day, bilious drainage appeared in the incision. Liver function test results were normal except for a minimally elevated alkaline phosphatase level. Hepatobiliary iminodiacetic acid scan was performed (Figure 1), followed by an endoscopic retrograde cholangiopancreaticogram (Figure 2).

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Figure 1.

Image from hepatobiliary iminodiacetic acid scan at 30 minutes.

Graphic Jump Location

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Figure 2.

Endoscopic retrograde cholangiopancreaticogram.

Graphic Jump Location

WHAT IS THE DIAGNOSIS?

A. Iatrogenic injury to the common bile duct

B. Cystic duct leak

C. Subvesical bile duct (Luschka) leak

D. Biliary shunt fistula

Figures

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Figure 1.

Image from hepatobiliary iminodiacetic acid scan at 30 minutes.

Graphic Jump Location
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Figure 2.

Endoscopic retrograde cholangiopancreaticogram.

Graphic Jump Location

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