Bile Duct Leaks
A small hole anywhere along the bile ducts can cause bile to leak into the abdominal cavity.
It can arise either as a complication of a surgery, such as gallbladder removal or liver transplant, or from trauma to the biliary system.
Bile leakage is an uncommon complication of cholecystectomy.
Bile leak after laparoscopic cholecystectomy is generally due to a minor biliary complication, although it can sometimes herald a major duct injury.
Several series have reported bile leakage rates of 1.2–4-0 per cent in laparoscopic cholecystectomy, which is higher than the incidence with open cholecystectomy.
The bile may originate from the gallbladder bed, the cystic duct or rarely from injury to a major bile duct.
The cystic duct stump and small peripheral right hepatic ducts within the liver bed account for most injuries of this type.
Those originating from the liver bed often remain asymptomatic.
Cystic stump leaks can occur from faulty clip application, slipping of the clips or necrosis of the cystic duct stump proximal to the clip, probably related to diathermy injury.
Bile, a digestive fluid produced by the liver and stored in the gallbladder, and is used by the body to break down fats so they can be absorbed.
The biliary system produces and transports bile into the duodenum to aid in digestion.
A bile duct leak can cause pain, inflammation and infection in the abdominal cavity where the bile has leaked.
Diagnosing a Bile Duct Leak
Labwork to evaluate for elevated liver enzymes.
A HIDA scan shows the flow of bile from the liver to the small intestine, and can demonstrate a leak. A leak can also be diagnosed by using a needle to remove a small amount of abdominal fluid. If the fluid contains bile, then a bile duct leak is confirmed.
Standard treatment is by endoscopic retrograde cholangiopancreatography (ERCP) with placement of a temporary bile duct stent.