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Rare bile leak from left triangular ligament
  1. Monali Shah1,
  2. Mihir M. Shah2 and
  3. David A. Kooby2
  1. 1Philadelphia College of Osteopathic Medicine, Moultrie, Georgia, USA
  2. 2Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
  1. Correspondence to Dr Mihir M. Shah; shahmihir_999{at}


Variations of the biliary system present challenges to abdominal operations and can affect postoperative outcomes. Bile leak is an uncommon complication of total gastrectomy. However, any procedure that involves mobilisation of the left lobes of the liver should be executed with additional caution. A thorough assessment including preoperative imaging for aberrant anatomy should be performed, especially aberrant bile ducts in the left triangular ligament. Ligation or suturing of the left triangular ligament should be considered when the aberrant anatomy suggests, to decrease the risk of postoperative bile leak. In addition, the left lateral segment of the liver should be thoroughly inspected on initial completion of the operation.

  • gastrointestinal surgery
  • general surgery
  • surgical oncology

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  • Contributors All authors assisted with planning, conducting, reporting, conception and design, analysis and writing the case report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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