Postoperative cystic duct bile leak can indicate an intraoperative migration of gallstones
Bile leak after laparoscopic cholecystectomy is not a rare postoperative complication. Causes are multiple and range from severe ones such as iatrogenic unobserved lesions to the main bile duct to relatively banal such as leakage from the small aberrant bile ducts from the gallbladder bed after removal. Intraoperative migration of gallstones with subsequent hypertension in the bile duct and subsequent bile leakage is not frequent and to diagnose it requires a high index of suspicion.
Our case presentation draws attention to one of the causes of postoperative bile leakage (intraoperative migration of gallstones). Multiple factors contribute to this complication: intraoperative manipulation of the gallbladder, large cystic duct, small gallstone, or microlithiasis.
In figure no. 1 (Cholangio-MRI) enhanced with contrast we can observe the almost complete obstruction of the distal choledochal due to a gallstone with a diameter of 0.5mm.
In figure no. 2 (ERCP) we can observe the main bile duct and the obstruction produced by the gallstone (arrow) also the location and distance it has traveled from the cistic duct (circle).
In figure no.3 (ERCP) after extraction, we can observe the complete projection of the main bile duct without any other obstructions.
In conclusion, this complication although rare is an important differential diagnosis for postoperative bile leakage and ERCP represents an elegant treatment.