Buscar en
Gastroenterología y Hepatología
Toda la web
Inicio Gastroenterología y Hepatología Subvesical duct injury resolved by percutaneous drainage
Información de la revista
Vol. 41. Núm. 3.
Páginas 172-174 (Marzo 2018)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 41. Núm. 3.
Páginas 172-174 (Marzo 2018)
Scientific letter
DOI: 10.1016/j.gastrohep.2017.03.005
Acceso a texto completo
Subvesical duct injury resolved by percutaneous drainage
Lesión del conducto subvesical resuelta por drenaje percutáneo
Visitas
...
Cristina Pineño-Flores, Juan José Segura-Sampedro
Autor para correspondencia
segusamjj@gmail.com

Corresponding author.
, José María García-Pérez, Carla Soldevila-Verdeguer, Elías Palma-Zamora, Francesc Xavier González-Argenté
Department of General and Digestive Surgery, Hospital Universitario Son Espases, Palma de Mallorca, Spain
Información del artículo
Texto completo
Bibliografía
Descargar PDF
Estadísticas
Figuras (2)
Texto completo

A 61-year-old woman underwent laparoscopic cholecystectomy due to cholelithiasis without any other medical history. The patient was discharged during the same day with no immediate complications.

The 8th day after the surgery she presented to the emergency department referring shoulder pain, without abdominal pain or any other symptoms. The physical examination was unremarkable and the blood test showed only leukocytosis (14600/μL) with neutrophilia (79.30%). The CT scan showed a collection at the gallbladder bed (Fig. 1). An external drainage catheter was placed, extracting serous fluid.

Figure 1.

Abdominal CT scan showing a collection at the gallbladder bed (arrow).

(0,12MB).

The 9th day after catheter placement an abdominal radiography with contrast was obtained (Fig. 2) showing a subvesical duct (duct of Luschka). The catheter produced bile after that, but remained afebrile and hemodynamically stable, without abdominal pain. The patient was discharged and required outpatient control until the debit stopped and the drainage was removed out of complications.

Figure 2.

Control image after catheter placement showing the subvesical duct (arrow).

(0,07MB).

Laparoscopic cholecystectomy is the treatment of choice for cholelithiasis and one of the most common surgical procedures performed.1 Postoperative biliary leaks remain a significant cause of morbidity in patients undergoing this procedure, occurring in 0.4–1.2% of cases.2 The cystic duct stump is the most common origin of bile leak (78%), followed by subvesicular duct (Luschka duct) in 13%.3

Most of the subvesicular bile ducts belong to biliary system of the right hepatic lobe, and are small (1–2cm in diameter). According to the Strasberg classification, it corresponds to a type A injury.

The clinical presentation may vary. Factors associated with this variability include the volume and distribution of bile in the peritoneal cavity, presence of sterile or infected bile, and presence or absence of a drain. Symptomatic patients after cholecystectomy should undergo investigations with ultrasound or CT scan. If a fluid collection is found, it should be drained under radiological guidance.4

There is no current consensus regarding gold standard treatment of post-operative biliary duct injuries. Some studies have indicated that bile leaks can be successfully treated in 78–100% of patients using endoscopic or radiological interventions.5 The treatment of leaking Luschka ducts depends on the clinical condition of the patients as well as on availability of imaging and interventional modalities.

In asymptomatic patients with low-output bile leaks, percutaneous external drainage might be enough. Avoiding ERCP will avoid the morbidity (ranges from 5 to 10%)6 as post-ERCP pancreatitis, bleeding or duodenal perforation which may occur. Spontaneous resolutions of the leak may arise when subvesicular ducts do not drain significant portions of the parenchyma.

If the leak originates from the end of a Luschka duct that communicates with the central biliary tree, output might be higher and resolution more difficult. In these cases, ERCP with sphincterotomy or percutaneous transhepatic biliary drainage will be required in order to decrease the intrabiliar pressure to allow its closure.

In patients where the bile leak persists despite the endoscopic or percutaneous management, or symptomatic patients with SIRS criteria, surgical reintervention will be necessary.7,8

Precise knowledge of the local anatomy as well as of anatomic variations decreases the risks as shown by the impact of surgeon experience on the frequency of biliary duct injuries. Staying close to the gallbladder wall during its removal from the fossa is the only known prophylactic measure.9 The final management of this condition will be decided based on the clinical status and the bile outputs.

References
[1]
W.Y. Lau, E.C.H. Lai.
Classification of iatrogenic bile duct injury.
Hepatobiliary Pancreat Dis Int, 6 (2007), pp. 459-463
[2]
T. Schnelldorfer, M.G. Sarr, D.B. Adams.
What is the duct of Luschka?—a systematic review.
J Gastrointest Surg, 16 (2012), pp. 656-662
[3]
C. Navarrete, J.M. Gobelet.
Treatment of common bile duct injuries after surgery.
Gastrointest Endosc Clin N Am, 22 (2012), pp. 539-553
[4]
C.P. Spanos, T. Syrakos.
Bile leaks from the duct of Luschka (subvesical duct): a review.
Langenbeck's Arch Surg, 391 (2006), pp. 441-447
[5]
Y.O. Eum, J.K. Park, J. Chun, S-H. Lee, J.K. Ryu, Y-T. Kim, et al.
Non-surgical treatment of post-surgical bile duct injury: clinical implications and outcomes.
World J Gastroenterol, 20 (2014), pp. 6924-6931
[6]
Y.-J. Jin, S. Jeong, J.H. Kim, J.C. Hwang, B.M. Yoo, J.H. Moon, et al.
Clinical course and proposed treatment strategy for ERCP-related duodenal perforation: a multicenter analysis.
Endoscopy, 45 (2013), pp. 806-812
[7]
F. Ruiz Gómez, J.M. Ramia Ángel, J. García-Parreño Jofré, J. Figueras.
Lesiones iatrogénicas de la vía biliar.
Cirugía Española, 88 (2010), pp. 211-221
[8]
J.J. Segura-Sampedro, J. Cañete-Gómez, J. Reguera-Rosal, F.J. Padillo-Ruiz, C.P. Ramírez-Plaza.
Unnoticed biloma due to liver puncture after Veress needle insertion.
Ann Med Surg, 4 (2015), pp. 238-239
[9]
S. Morales-Conde, J. Cañete-Gómez, V. Gómez, M. Socas Macías, A.B. Moreno, I.A. Del Agua, et al.
Laparoendoscopic single-site cholecystectomy: first experiences with a new standardized technique replicating the four-port technique.
J Laparoendosc Adv Surg Tech A, 26 (2016), pp. 812-815
Copyright © 2017. Elsevier España, S.L.U.. All rights reserved
Opciones de artículo
Herramientas
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

es en pt
Política de cookies Cookies policy Política de cookies
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here. Utilizamos cookies próprios e de terceiros para melhorar nossos serviços e mostrar publicidade relacionada às suas preferências, analisando seus hábitos de navegação. Se continuar a navegar, consideramos que aceita o seu uso. Você pode alterar a configuração ou obter mais informações aqui.