The Rare Sequela of Postoperative Biliary Leakage in a Patient with Gallstone Intestinal Obstruction

Abstract

A 48-year-old man who had been diagnosed as having intestinal obstruction caused by a cholecystoduodenal fistula and common bile duct stone was referred to our hospital. We performed laparotomy with subtotal cholecystectomy and distal gastrectomy. On the 3rd postoperative day, the patient developed vomiting, and an abdominal CT showed significant dilatation of the duodenum and common bile duct. Ascites was also observed. We performed emergent surgery for bile leakage. Intraoperatively, the gastrojejunal anastomosis and the Braun anastomosis were found to be twisted by approximately 90 degrees. The Braun anastomosis was resected, and Roux-en-Y reconstruction was performed. Transient bowel paralysis was observed postoperatively, but the postoperative course was otherwise satisfactory. We believe that the patient developed the rare sequela of biliary leakage from the gallbladder stump. It is possible that the bile leakage was caused by bile duct reflux due to endoscopic sphincterotomy (EST) and intestinal obstruction.