Delayed bile leakage after laparoscopic cholecystectomy emerged with right lower abdominal pain; Report of a case

Abstract

We encountered a 50's male complaining of occasional colic attacks over 16 years with a desire for laparoscopic cholecystectomy. Several stones were observed in the wall-thickened gall bladder. Dissection around the cystic duct had been difficult but cholecystectomy was completed. The patient was discharged uneventfully on the 4th POD. However he returned with pain in the lower right abdomen. The CT showed a liquid collection in the pelvic cavity. The patient was readmitted on the 10th POD on grounds of peritonitis. On exploration of emergent laparotomy, bile peritonitis became apparent from a hole 1 mm in size where bile flow could be seen at the CBD. After peritoneal lavage, bile drainage was performed from this hole. On verification from laparoscopic video tapes, the rupture was caused by repeated contact with the shaft of forceps during dissection. He was discharged on the 16th POD uneventfully. Careful manipulation of forceps is crucial at and around the operation site.