Localized Abdominal Wall Bile Staining Due To Retroperitoneal Bile Leak

A Case Report and Literature Review of Icterus Marginatus: Demarcated Subcutaneous Jaundice, A Sign of Retroperitoneal Bile Leak After Laparoscopic Cholecystectomy

“…Despite the significant intra-abdominal pathology of this skin demarcation, all patients had good outcomes and went home except for one who passed away due to pulmonary issues. In one case, the patient's outcome was not mentioned [13][14][15][16].…”

Abdominal Wall Bile Staining Without Jaundice

“…1 Localized abdominal wall pigmentation caused by a postcholecystectomy bile leak is exceptionally rare. [2][3][4] Ranosohoff first described a localized yellow umbilical stain in a patient with a ruptured common bile duct in 1906. 2 A more recent case described yellow pigmentation involving the loin after an ERCP procedure resulted in duodenal perforation, causing retroperitoneal hematoma and bleeding, although bile was not present during the open surgical repair.…”

“…[2][3][4] Ranosohoff first described a localized yellow umbilical stain in a patient with a ruptured common bile duct in 1906. 2 A more recent case described yellow pigmentation involving the loin after an ERCP procedure resulted in duodenal perforation, causing retroperitoneal hematoma and bleeding, although bile was not present during the open surgical repair. 2 Other reported cases included pigmentation of the chest and groin area caused by a bile leak, 3 and of the scrotum and pubis caused by a duodenal perforation.…”

“…2 A more recent case described yellow pigmentation involving the loin after an ERCP procedure resulted in duodenal perforation, causing retroperitoneal hematoma and bleeding, although bile was not present during the open surgical repair. 2 Other reported cases included pigmentation of the chest and groin area caused by a bile leak, 3 and of the scrotum and pubis caused by a duodenal perforation. 4 Nontraumatic localized abdominal wall skin changes, such as of the flanks (Grey Turner's sign) and periumbilical region (Cullen's sign) can be concerning for retroperitoneal bleeding, especially after a recent surgical procedure.…”

“…4 Nontraumatic localized abdominal wall skin changes, such as of the flanks (Grey Turner's sign) and periumbilical region (Cullen's sign) can be concerning for retroperitoneal bleeding, especially after a recent surgical procedure. 2 In such instances, the extravasated blood spreads through various anatomic planes to produce subcutaneous ecchymosis. In a similar fashion, extravasated bile can follow natural pathways in the abdominal cavity, reaching the skin to induce yellow macules and patches.…”