IS Case 68: Bile Leak at Ducts of Luschka

Scott Cassar, MD


Imaging Sciences URMC 2008
Publication Date: 2009-05-19

History

A 51-year-old male with abdominal pain underwent endoscopic retrograde cholangiopancreatography (ERCP) for clinical suspicion of a common bile duct stone or bile leak one week status post-cholecystectomy.

Findings

Single fluoroscopic image of the right upper abdominal quadrant during ERCP reveals a cystic duct remnant and a focal area of contrast in the inferior right hepatic lobe consistent with small leak.

Diagnosis

Bile Leak at Ducts of Luschka

Discussion

The duct of Luschka is a small accessory bile duct in the right hepatic lobe which is located very close to the gallbladder bed and drains into the right or common hepatic duct. The duct reaches the gallbladder adventitial layer but does not enter the gallbladder lumen. The prevalence of this anatomic variation is estimated at one-third of the population. Injury to the duct of Luschka during laparoscopic cholecystectomy is extremely rare. One study reported two cases of bile leakage due to duct injury in a series of 1351 laparoscopic cholecystectomies. Symptoms generally appear between the 5th and 8th postoperative days and include abdominal pain with fever, local or general sepsis, or more mild nonspecific symptoms.

The least invasive treatment option is endoscopic insertion of a biliary stent, theoretically releasing pressure on the duct allowing it to close and percutaneous drainage of a biloma if present. In the setting of an acute abdomen, exploratory laparotomy with lavage of the peritoneal cavity and closure of the duct of Luschka is performed.

References

  1. Aoki T, Imamura H, Sakamoto Y, et al. Bile duct of Luschka connecting with the cystohepatic duct: the importance of cholangiography during surgery. AJR Am J Roentgenol. 2003 Mar;180(3):694-6. [PMID: 12591676]
  2. Braghetto I, Bastias J, Csendes A, Debandi A. Intraperitoneal bile collections after laparoscopic cholecystectomy: causes, clinical presentation, diagnosis, and treatment. Surg Endosc. 2000 Nov;14(11):1037-41. [PMID: 11116414]
  3. Ramia JM, Muffak K, Mansilla A, et al. Postlaparoscopic cholecystectomy bile leak secondary to an accessory duct of Luschka. JSLS. 2005 Apr-Jun;9(2):216-7. [PMID: 15984714]

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