Curbside Consultation in Endoscopy: 49 Clinical Questions, Second Edition

Joseph Leung, MD; Simon Lo, MD

Question 23: A 55-Year-Old Veteran Had A Ruptured Gallbladder And A Difficult Cholecystectomy. Postoperatively, The Patient Had Persistent Bile Leakage Despite Months Of Multiple Biliary Stenting. What Can I Do? (continued)

Catherine Ngo, MD; Joseph Leung, MD, FRCP, FACP, FASGE, MACG

Bile leakage occurs as a result of injury to the biliary system. The cystic duct stump is the most common cause of a bile leak following cholecystectomy. Less common, but more serious, causes are injury to the bile duct and (rarely) transection of an aberrant branch duct to the right lobe in close proximity to the cystic duct. In the latter case, persistent bile leakage occurs from the more proximal bile duct, which is isolated from the main system. Injury to the bile duct may result in persistent leakage if there is significant damage to the bile duct wall. In cases with difficult…