Ducts of Luschka as a rare cause of postoperative biloma. MRCP findings

Abstract

Laparoscopic cholecystectomy can be complicated by a post- operative biloma. Bile leak from the duct of Luschka is reported to be the second most frequent cause, reported in 0.15%-2% of the patients. This case report aims to underline the significance of this anatomic variation and how the management of the aforementioned complication can be facilitated by MRI- MRCP. A 78 year old male patient underwent an elective laparoscopic cholecystectomy and was found to have a post-operative biloma. An MRCP was carried out to visualize the bile tree and bile leak was identified to be originated from a duct of Luschka. The patient was referred for an ERCP, sphingterotomy and placement of biliary stent to release the pressure in the bile ducts. In the next few days the bile leak was controlled and eventually ceased. The patient was discharged free of symptoms and no sign of bile leak was to be found on his follow up imaging. In comparison with other imaging modalities picturing the bile tree, MRCP fits the ideal profile to be used as a first line choice for clinicians, as it offers detailed anatomical images with high contrast between bile and adjacent tissues, without using any contrast agent or radiation.

Utility of Dynamic Hepatobiliary Scintigraphy in Identifying a Duct of Luschka Bile Leak

“…1,2 Studies have suggested that subvesicular duct injury may occur in only 0.15% to 2% of patients undergoing laparoscopic cholecystectomy; however, it is one of the most common causes of a postcholecystectomy bile leak. [1][2][3][4] As such, it is important to recognize the imaging manifestations of accessory duct injury to appropriately guide patient management. While ERCP and MRCP are both sensitive and specific at identifying an accessory duct in the setting of suspected injury, 5,6 hepatobiliary scintigraphy has traditionally been used only as a binary test to detect whether a leak is present or not.…”

“…A subvesical bile duct, often referred to as a duct of Luschka, is a small accessory duct that courses along the gallbladder fossa and drains into the right hepatic or common hepatic duct 1,2 . Studies have suggested that subvesicular duct injury may occur in only 0.15% to 2% of patients undergoing laparoscopic cholecystectomy; however, it is one of the most common causes of a postcholecystectomy bile leak 1–4 . As such, it is important to recognize the imaging manifestations of accessory duct injury to appropriately guide patient management.…”