Skip to main content
Erschienen in: European Surgery 1/2018

30.11.2017 | case report

Bile leak from the gallbladder fossa after liver transplantation

verfasst von: Hugo J. R. Bonatti, MD, Michael R. Corey, Joshua T. Taylor, Sunil K. Geevarghese

Erschienen in: European Surgery | Ausgabe 1/2018

Einloggen, um Zugang zu erhalten

Summary

Background

Bile leaks are common complications following liver transplantation (LT). The majority of leaks involve the anastomosis but other sites should be considered. Bile leaks are associated with biliary peritonitis and intra-abdominal abscess formation. Subvesical bile ducts formerly called ducts of Luschka are aberrant bile ducts in the gallbladder fossa. Leaks from this structure have been reported following laparoscopic cholecystectomy. Only three cases of leaks from this duct after LT have been thus far reported.

Case report

A 43-year-old man with a MELD (model for end stage liver disease) score of 29 underwent an uncomplicated LT for hepatitis C–cirrhosis and reformed alcohol abuse. Four days after discharge he developed significant abdominal pain and leukocytosis of 16,000/ml; AST was 23 IU/l and total bilirubin 2.0 mg/dl. A computed tomography scan showed massive ascites and a perihepatic hematoma. Paracentesis (5 l) revealed 10,000 nucleated cells, 98% neutrophils, and a bilirubin level of 3.4 mg/dl. Antibiotics were started; endoscopic retrograde cholangiopancreatography showed a patent anastomosis but a small leak from a side branch of the right hepatic duct. A transampullary common bile duct stent was placed. The patient developed increasing abdominal pain, ileus, and underwent laparotomy during which the perihepatic hematoma was evacuated and a bile leak from a subvesical bile duct was identified and oversewn. Cultures grew Escherichia coli and antibiotics were continued. The patient recovered from the complication and the biliary stent was removed after the leak had completely sealed. The patient is alive with a well-functioning graft 4 years after the procedure.

Conclusion

Leaks from subvesical bile ducts are rare complications in LT recipients, but should be recognized as a source of intra-abdominal infection.
Literatur
1.
Zurück zum Zitat Melcher ML, Freise CE, Ascher NL, Roberts JP. Outcomes of surgical repair of bile leaks and strictures after adult-to-adult living donor liver transplant. Clin Transplant. 2010;24(6):E230–E5.CrossRef Melcher ML, Freise CE, Ascher NL, Roberts JP. Outcomes of surgical repair of bile leaks and strictures after adult-to-adult living donor liver transplant. Clin Transplant. 2010;24(6):E230–E5.CrossRef
2.
Zurück zum Zitat Thuluvath PJ, Atassi T, Lee J. An endoscopic approach to biliary complications following orthotopic liver transplantation. Liver Int. 2003;23(3):156–62.CrossRef Thuluvath PJ, Atassi T, Lee J. An endoscopic approach to biliary complications following orthotopic liver transplantation. Liver Int. 2003;23(3):156–62.CrossRef
3.
Zurück zum Zitat Wojcicki M, Milkiewicz P, Silva M. Biliary tract complications after liver transplantation: a review. Dig Surg. 2008;25(4):245–57.CrossRef Wojcicki M, Milkiewicz P, Silva M. Biliary tract complications after liver transplantation: a review. Dig Surg. 2008;25(4):245–57.CrossRef
4.
Zurück zum Zitat Boonstra EA, Lorenz K, Porte RJ. The quest for Luschka’s duct: an eponym leading a life of its own? Dig Surg. 2014;31(2):104–7.CrossRef Boonstra EA, Lorenz K, Porte RJ. The quest for Luschka’s duct: an eponym leading a life of its own? Dig Surg. 2014;31(2):104–7.CrossRef
5.
Zurück zum Zitat Schnelldorfer T, Sarr MG, Adams DB. What is the duct of Luschka?—A systematic review. J Gastrointest Surg. 2012;16(3):656–62.CrossRef Schnelldorfer T, Sarr MG, Adams DB. What is the duct of Luschka?—A systematic review. J Gastrointest Surg. 2012;16(3):656–62.CrossRef
6.
Zurück zum Zitat Champetier J, Letoublon C, Alnaasan I, Charvin B. The cystohepatic ducts: surgical implications. Surg Radiol Anat. 1991;13(3):203–11.CrossRef Champetier J, Letoublon C, Alnaasan I, Charvin B. The cystohepatic ducts: surgical implications. Surg Radiol Anat. 1991;13(3):203–11.CrossRef
7.
Zurück zum Zitat Ko K, Kamiya J, Nagino M, Oda K, Yuasa N, Arai T, et al. A study of the subvesical bile duct (duct of Luschka) in resected liver specimens. World J Surg. 2006;30(7):1316–20.CrossRef Ko K, Kamiya J, Nagino M, Oda K, Yuasa N, Arai T, et al. A study of the subvesical bile duct (duct of Luschka) in resected liver specimens. World J Surg. 2006;30(7):1316–20.CrossRef
8.
Zurück zum Zitat Luschka H. Die Anatomie des menschlichen Bauches. 1863. Luschka H. Die Anatomie des menschlichen Bauches. 1863.
9.
Zurück zum Zitat Spanos CP, Syrakos T. Bile leaks from the duct of Luschka (subvesical duct): a review. Langenbecks Arch Surg. 2006;391(5):441–7.CrossRef Spanos CP, Syrakos T. Bile leaks from the duct of Luschka (subvesical duct): a review. Langenbecks Arch Surg. 2006;391(5):441–7.CrossRef
10.
Zurück zum Zitat Sicklick JK, Camp MS, Lillemoe KD, Melton GB, Yeo CJ, Campbell KA, et al. Surgical management of bile duct injuries sustained during laparoscopic cholecystectomy: perioperative results in 200 patients. Ann Surg. 2005;241(5):786–92. discussion 93–5.CrossRef Sicklick JK, Camp MS, Lillemoe KD, Melton GB, Yeo CJ, Campbell KA, et al. Surgical management of bile duct injuries sustained during laparoscopic cholecystectomy: perioperative results in 200 patients. Ann Surg. 2005;241(5):786–92. discussion 93–5.CrossRef
11.
Zurück zum Zitat Sharif K, de Ville de Goyet J. Bile duct of Luschka leading to bile leak after cholecystectomy—revisiting the biliary anatomy. J Pediatr Surg. 2003;38(11):E21–E3.CrossRef Sharif K, de Ville de Goyet J. Bile duct of Luschka leading to bile leak after cholecystectomy—revisiting the biliary anatomy. J Pediatr Surg. 2003;38(11):E21–E3.CrossRef
12.
Zurück zum Zitat Ramia JM, Muffak K, Mansilla A, Villar J, Garrote D, Ferron JA. Postlaparoscopic cholecystectomy bile leak secondary to an accessory duct of Luschka. JSLS. 2005;9(2):216–7.PubMedPubMedCentral Ramia JM, Muffak K, Mansilla A, Villar J, Garrote D, Ferron JA. Postlaparoscopic cholecystectomy bile leak secondary to an accessory duct of Luschka. JSLS. 2005;9(2):216–7.PubMedPubMedCentral
13.
Zurück zum Zitat Booij KA, de Reuver PR, Yap K, van Dieren S, van Delden OM, Rauws EA, et al. Morbidity and mortality after minor bile duct injury following laparoscopic cholecystectomy. Endoscopy. 2015;47(1):40–6.PubMed Booij KA, de Reuver PR, Yap K, van Dieren S, van Delden OM, Rauws EA, et al. Morbidity and mortality after minor bile duct injury following laparoscopic cholecystectomy. Endoscopy. 2015;47(1):40–6.PubMed
14.
Zurück zum Zitat Albishri SH, Issa S, Kneteman NM, Shapiro AM. Bile leak from duct of Luschka after liver transplantation. Transplantation. 2001;72(2):338–40.CrossRef Albishri SH, Issa S, Kneteman NM, Shapiro AM. Bile leak from duct of Luschka after liver transplantation. Transplantation. 2001;72(2):338–40.CrossRef
15.
Zurück zum Zitat Rochon C, Metrakos P, Tchervenkov JI, Fernandez M, Paraskevas S, Barkun J, et al. Endoscopic stenting as first-line treatment in duct of Lushka leaks after choledochocystic anastomosis in two cases of liver transplantation. Transplantation. 2005;79(6):740–1.CrossRef Rochon C, Metrakos P, Tchervenkov JI, Fernandez M, Paraskevas S, Barkun J, et al. Endoscopic stenting as first-line treatment in duct of Lushka leaks after choledochocystic anastomosis in two cases of liver transplantation. Transplantation. 2005;79(6):740–1.CrossRef
16.
Zurück zum Zitat Macias-Gomez C, Dumonceau JM. Endoscopic management of biliary complications after liver transplantation: an evidence-based review. World J Gastrointest Endosc. 2015;7(6):606–16.CrossRef Macias-Gomez C, Dumonceau JM. Endoscopic management of biliary complications after liver transplantation: an evidence-based review. World J Gastrointest Endosc. 2015;7(6):606–16.CrossRef
17.
Zurück zum Zitat Faleschini G, Vadala di Prampero SF, Bulajic M, Baccarani U, Toniutto P, Panic N, et al. Predictors of endoscopic treatment outcome in the management of biliary complications after orthotopic liver transplantation. Eur J Gastroenterol Hepatol. 2015;27(2):150–4.CrossRef Faleschini G, Vadala di Prampero SF, Bulajic M, Baccarani U, Toniutto P, Panic N, et al. Predictors of endoscopic treatment outcome in the management of biliary complications after orthotopic liver transplantation. Eur J Gastroenterol Hepatol. 2015;27(2):150–4.CrossRef
Metadaten
Titel
Bile leak from the gallbladder fossa after liver transplantation
verfasst von
Hugo J. R. Bonatti, MD
Michael R. Corey
Joshua T. Taylor
Sunil K. Geevarghese
Publikationsdatum
30.11.2017
Verlag
Springer Vienna
Erschienen in
European Surgery / Ausgabe 1/2018
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-017-0505-x

Weitere Artikel der Ausgabe 1/2018

European Surgery 1/2018 Zur Ausgabe