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Special Feature |

Image of the Month—Quiz Case FREE

Deepa Magge, MD; Allan Tsung, MD; David A. Geller, MD
[+] Author Affiliations

Author Affiliations:Starzl Transplant Institute, University of Pittsburgh Department of Surgery, Pittsburgh, Pennsylvania.


Section Editor: Carl E. Bredenberg, MD


Arch Surg. 2010;145(11):1123. doi:10.1001/archsurg.2010.236-a.
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Published online

A 50-year-old woman who had laparoscopic cholecystectomy for symptomatic cholelithiasis at an outside hospital developed symptoms of abdominal pain, nausea, and vomiting 1 week postoperatively. She initially underwent an abdominal ultrasound, which did not reveal any abnormalities. Subsequent endoscopic retrograde cholangiopancreatography (ERCP) also failed to reveal the cause of her symptoms. An abdominal computed tomographic scan was then performed, which demonstrated a biloma adjacent to the gallbladder fossa. A percutaneous abdominal catheter was placed and drained approximately 400 to 500 mL of bile per day. After a second ERCP was performed, which again failed to delineate a bile leak, the patient was transferred to our institution for further treatment.

On admission to our facility, a repeated ERCP was performed by our institution's gastroenterology service (Figure 1). A hepatobiliary iminodiacetic acid scan showed a persistent biliary leak (Figure 2). She was discharged to home with the abdominal drainage catheter in place to determine if the bile leak would resolve spontaneously. Because the patient continued to drain approximately 500 mL of bile per day at home, she was readmitted 10 days later for further treatment.

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Figure 1.

Hepatobiliary iminodiacetic acid scan shows bile leak into gallbladder fossa.

Graphic Jump Location

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Figure 2.

Endoscopic retrograde cholangiopancreatography read as normal.

Graphic Jump Location

WHAT IS THE DIAGNOSIS?

A. Common bile duct injury

B. Transected right posterior hepatic duct

C. Cystic duct leak

D. Duct of Luschka leak

Figures

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Figure 1.

Hepatobiliary iminodiacetic acid scan shows bile leak into gallbladder fossa.

Graphic Jump Location
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Figure 2.

Endoscopic retrograde cholangiopancreatography read as normal.

Graphic Jump Location

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