Skip to main content
SpringerLink
Log in

Bile leak from the gallbladder fossa after liver transplantation

  • case report
  • Published:
European Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

References

  1. 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.

    Article  Google Scholar 

  2. Thuluvath PJ, Atassi T, Lee J. An endoscopic approach to biliary complications following orthotopic liver transplantation. Liver Int. 2003;23(3):156–62.

    Article  Google Scholar 

  3. Wojcicki M, Milkiewicz P, Silva M. Biliary tract complications after liver transplantation: a review. Dig Surg. 2008;25(4):245–57.

    Article  Google Scholar 

  4. 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.

    Article  Google Scholar 

  5. Schnelldorfer T, Sarr MG, Adams DB. What is the duct of Luschka?—A systematic review. J Gastrointest Surg. 2012;16(3):656–62.

    Article  Google Scholar 

  6. Champetier J, Letoublon C, Alnaasan I, Charvin B. The cystohepatic ducts: surgical implications. Surg Radiol Anat. 1991;13(3):203–11.

    Article  CAS  Google Scholar 

  7. 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.

    Article  Google Scholar 

  8. Luschka H. Die Anatomie des menschlichen Bauches. 1863.

    Google Scholar 

  9. Spanos CP, Syrakos T. Bile leaks from the duct of Luschka (subvesical duct): a review. Langenbecks Arch Surg. 2006;391(5):441–7.

    Article  Google Scholar 

  10. 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.

    Article  Google Scholar 

  11. 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.

    Article  CAS  Google Scholar 

  12. 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.

    CAS  PubMed  PubMed Central  Google Scholar 

  13. 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  Google Scholar 

  14. Albishri SH, Issa S, Kneteman NM, Shapiro AM. Bile leak from duct of Luschka after liver transplantation. Transplantation. 2001;72(2):338–40.

    Article  CAS  Google Scholar 

  15. 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.

    Article  Google Scholar 

  16. 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.

    Article  Google Scholar 

  17. 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.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

    Hugo J. R. Bonatti MD & Sunil K. Geevarghese

  2. Surgical Care, University of Maryland Community Medical, 500 Cadmus Lane Suite 280, 21601, Easton, MD, USA

    Hugo J. R. Bonatti MD

  3. Vascular Surgical Associates, Marietta, GA, USA

    Michael R. Corey

  4. The Surgical Clinic, Smyrna, TN, USA

    Joshua T. Taylor

Authors
  1. Hugo J. R. Bonatti MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael R. Corey
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joshua T. Taylor
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sunil K. Geevarghese
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hugo J. R. Bonatti MD.

Ethics declarations

Conflict of interest

H.J. R. Bonatti, M.R. Corey, J.T. Taylor, and S.K. Geevarghese declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bonatti, H.J.R., Corey, M.R., Taylor, J.T. et al. Bile leak from the gallbladder fossa after liver transplantation. Eur Surg 50, 33–36 (2018). https://doi.org/10.1007/s10353-017-0505-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10353-017-0505-x

Keywords

Search

Navigation