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CASE REPORT
Retroperitoneal bile leak after laparoscopic cholecystectomy
  1. Dee Zhen LIM1,
  2. Enoch Wong2,
  3. Sayed Hassen2,
  4. Yahya AL-Habbal2
  1. 1School of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
  2. 2Department of General Surgery, Eastern Health, Box Hill, Victoria, Australia
  1. Correspondence to Yahya AL-Habbal, yahya{at}alhabbal.info

Summary

Bile duct injury (BDI) is a well-recognised complication of laparoscopic cholecystectomy (LC). Following a BDI, bile usually leaks into the peritoneal space and causes biliary peritonitis. This manifests as non-specific abdominal pain and fever occurring several days after the surgery. It can be managed by laparoscopic washout with or without bile duct repair. We present a rare case of retroperitoneal bile leak post-LC. The mechanism of injury here was likely partial avulsion from excessive traction of the cystic duct during intraoperative cholangiogram. Diagnosing retroperitoneal bile leak can be difficult because it is extremely rare and the presenting symptoms can be similar to an intraperitoneal bile leak. A high index of clinical suspicion is required. In cases of suspected bile leak, any mismatch between the exploratory laparoscopic findings and imaging findings should alert surgeons to consider the rare possibility of a retroperitoneal bile leak.

  • biliary intervention
  • surgical diagnostic tests
  • interventional radiology
  • gastrointestinal surgery
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Footnotes

  • Contributors DZL performed the literature review and drafted the manuscript. EW, YA-H and SH were responsible for providing guidance, critical revision, editing, proof-reading and supervision for the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

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

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