Abstract
A 67-year-old female presented with intermittent right upper quadrant pain. A gallstone was visualized on ultrasonography and CT. First, extracorporeal shock wave lithotripsy (ESWL) was attempted 4 times but abdominal discomfort prevented completion of the treatment. Laparoscopic cholecystecomy was then performed. The gallbladder was almost normal laparoscopically. Cannulation of the cystic duct for an intraoperative cholangiogram was unsuccessful and a drip intravenous cholangiogram (DIC) was performed. The cystic duct could not, however, be clearly visualized. The duct was divided after clipping. No biliary leakage was detectable at the end of the surgery. On the first postoperative day (POD), substantial biliary leakage from the abdominal drain occurred. Endoscopic retrograde cholangiography (ERC) was performed immediately and the contrast material was seen to be leaking from the remnant cystic duct. A naso-biliary drainage (ENBD) tube was then placed, producing a marked reduction in biliary leakage from the abdominal drain. The abdominal drain was removed on the 4th POD. A cholangiogram obtained on the 7th POD confirmed the cessation of leakage from the cystic duct, and the ENBD tube was extracted on the 14th POD. The patient was discharged from the hospital. We present herein the clinical course of a case in which biliary leakage, following laparoscopic cholecystectomy, was successfully managed with ENBD rather than surgery.
