A case of spontaneous bile leak

Peng, Calvin; Chubb, Daniel; Thomson, Benjamin; Miller, Francis

doi:10.1111/ans.13409

Cited by 2 publications

(1 citation statement)

References 4 publications

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“…However, a large body of research defines bile leak as a broader term. Using the PubMed search function, a significant amount of literature was found that referred to "spontaneous bile leak," a term used to refer to a leakage of biliary fluid that did not follow surgical intervention of any kind [4,[9][10][11][12][13]. Spontaneous bile leak has been defined as a bile leak "where a specific cause remains unidentifiable and is usually a diagnosis of exclusion" [9].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Bile Leak in a Patient Without Recent Abdominal Surgery or Trauma

Micheli

Patel

et al. 2021

Cureus

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Bile leaks are a rare occurrence most often seen as a complication of cholecystectomy. Other less common etiologies include endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC), liver surgery, percutaneous drainage of liver abscesses, living donor hepatectomy, and non-iatrogenic abdominal trauma. In this case study, we present a 67-year-old female with morbid obesity who presented with abdominal pain and was diagnosed with a spontaneous bile leak. She had no history of recent surgery or abdominal trauma. CT revealed that the patient's gallbladder was located in the right lower quadrant, most likely due to mass effect from a large ventral hernia, and possible fluid collection extending from the gallbladder along the surface of the anterior inferior right hepatic lobe. Hepatobiliary iminodiacetic acid (HIDA) was performed due to a concern for cholecystitis. HIDA demonstrated a bile leak in the right upper abdomen of unknown etiology. Initially, there was a concern for gallbladder obstruction. Gastroenterology recommended magnetic resonance cholangiopancreatography (MRCP), however, MRCP was not possible due to the patient's body habitus. The patient had normal liver function tests, was tolerating oral intake, and her abdominal pain resolved, therefore, we became less suspicious of gallbladder obstruction. This case suggests that bile leak should be included in the differential diagnosis for abdominal pain even in patients who have not had recent abdominal surgery or procedures. This case also highlights the unique anatomical finding of a right lower quadrant gallbladder secondary to mass effect from a large ventral hernia.

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Section: Discussionmentioning

confidence: 99%

Spontaneous Bile Leak in a Patient Without Recent Abdominal Surgery or Trauma

Micheli

Patel

et al. 2021

Cureus

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Spontaneous perforation in the bile duct system

Sigua,

Rakita,

Rud

et al. 2023

Ann. hir. gepatol.

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Aim. To evaluate different therapeutic and diagnostic approaches in spontaneous bile duct perforation.Materials and methods. The present study involved the reports on spontaneous perforations in the bile duct system, published from 01.01.2000 to 01.06.2022 and selected by structured search in PubMed/Medline database.Results. As a result, 58 articles describing 71 patients were selected for the study. The most frequent symptoms of the disease included abdominal pain (92.9%), fever (39.4%), and jaundice (33%). The provisional diagnosis was made correctly in 52.1% of cases. The development of the disease was most often associated with choledocholithiasis (38%). Bile ducts perforation of the left hepatic lobe was revealed in 40.6% of cases, perforation of the common bile duct – in 35.5%. Bile duct perforation resulted in peritonitis in 42.2% of patients and bile accumulation or abscess in 30.9%. Encapsulated and intrahepatic accumulation of bile was found in 18.3% of cases. Management of perforations with development of encapsulated and intrahepatic bile accumulation included combined treatment, embracing percutaneous transhepatic drainage and endoscopic methods. Perforation of bile ducts with development of extensive forms of the disease required two-stage treatment. The first stage involved lavage of the abdominal cavity and decompression of the biliary tract. The second stage involved resective and reconstructive surgery to eliminate the cause of the perforation. The mortality rate was 5.6%.Conclusion. Spontaneous perforation in the bile duct system is a rare pathological state appeared as a complication of hepatopancreaticoduodenal diseases. Its management requires greater awareness of abdominal surgeons. The surgical strategy is based on correctly diagnosed and staged treatment tactics, which allows the incidence of complications and mortality rate to be reduced.

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A case of spontaneous bile leak

Abstract: Fig. 3. Endoscopic retrograde cholangiopancreatography demonstrating leak from a segment IVb subsegmental duct. 2Images for surgeons

Cited by 2 publications

References 4 publications

Spontaneous Bile Leak in a Patient Without Recent Abdominal Surgery or Trauma

Spontaneous Bile Leak in a Patient Without Recent Abdominal Surgery or Trauma

Spontaneous perforation in the bile duct system

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