Abstract: Introduction: Bile peritonitis is one of the rare complications that can occur after cholecystectomy or hepatectomy. It is associated with high mortality, prolonged hospital stay, and increased cost. We herein report 2 cases of bile leakage as a postoperative complication of right hemicolectomy.
Patient Concerns: Two patients underwent a right hemicolectomy for colon cancer. Both patients had a history of cholecystectomy, and intrahepatic bile duct dilatation was observed in preoperative imaging study. During surgery, adhesiolysis was performed between the liver and the hepatic flexure of the colon due to adhesion in that area.
Diagnosis: Postoperatively, bile fluid was drained via an intraabdominal drainage tube. Both cases required surgical intervention to explore the origin of the leakage. In both cases, the anastomosis was intact, and the injury of the intrahepatic bile duct just beneath the liver surface was the origin of bile leakage.
Interventions: Suture ligation, irrigation, and drainage were performed in both patients.
Outcomes: There was no more bile leakage after reoperation, and both patients were discharged in good health after antibiotics treatment.
Conclusion: Although very rare, bile leakage due to intrahepatic duct injury can occur after right hemicolectomy in patients with a history of cholecystectomy and intrahepatic duct dilatation. It is necessary to consider the possibility of bile duct injury and anastomotic leakage if bile leakage is suspected after right hemicolectomy.
Competing Interests: The authors have no funding and conflicts of interest to disclose.
(Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)
References: Andersson R, Tranberg KG, Bengmark S. Roles of bile and bacteria in biliary peritonitis. Br J Surg 1990;77:36–9.
Spetzler VN, Schepers M, Pinnschmidt HO, Fischer L, Nashan B, Li J. The incidence and severity of post-hepatectomy bile leaks is affected by surgical indications, preoperative chemotherapy, and surgical procedures. Hepatobiliary Surg Nutr 2019;8:101–10.
Kapoor S, Nundy S. Bile duct leaks from the intrahepatic biliary tree: a review of its etiology, incidence, and management. HPB Surg 2012;2012:752932.
Shukla RM, Roy D, Mukherjee PP, et al. Spontaneous gall bladder perforation: a rare condition in the differential diagnosis of acute abdomen in children. J Pediatr Surg 2011;46:241–3.
Cai W, Pan K, Li Q, Miao X, Shu C. Biliary peritonitis due to spontaneous perforation of the left intrahepatic bile duct in an adult: a case report and review of literature. Int Surg 2018;103:339–43.
Kang SB, Han HS, Min SK, Lee HK. Nontraumatic perforation of the bile duct in adults. Arch Surg 2004;139:1083–7.
Tanaka S, Hirohashi K, Tanaka H, et al. Incidence and management of bile leakage after hepatic resection for malignant hepatic tumors. J Am Coll Surg 2002;195:484–9.
Koch M, Garden OJ, Padbury R, et al. Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the international study group of liver surgery. Surgery 2011;149:680–8.
Zhang GW, Lin JH, Qian JP, Zhou J. Analyzing risk factors for early postoperative bile leakage based on clavien classification in bile duct stones. Int J Surg 2014;12:757–61.
El-Gendi AM, El-Shafei M, Bedewy E. The role of prophylactic endoscopic sphincterotomy for prevention of postoperative bile leak in hydatid liver disease: a randomized controlled study. J Laparoendosc Adv Surg Tech A 2018;28:990–6.
Capussotti L, Ferrero A, Viganò L, Sgotto E, Muratore A, Polastri R. Bile leakage and liver resection. Arch Surg 2006;141:690–4.
Giri S, Sundaram S, Darak H, Kumar S, Bhatia S. Outcomes of endoscopic management among patients with bile leak of various etiologies at a tertiary care center. Clin Endosc 2020;53:727–34.
Stampfl U, Hackert T, Radeleff B, et al. Percutaneous management of postoperative bile leaks after upper gastrointestinal surgery. Cardiovasc Intervent Radiol 2011;34:808–15.
Processing Request
No Comments.