Post-operative biloma caused by unusual detection of luschka duct: demonstration with MRCP

Abstract

Introduction: Laparoscopic cholecystectomy is currently regarded as the optimal treatment method for cholelithiasis. Normal anatomy of the biliary tree is reported to be found in only 58% of the population. Duct of Luschka represents a well-known and widely reported anatomic variation of the biliary tree which may lead to bile leakage if injured during hepatobiliary surgery. Methods: We report a case of 71 years old man presented to our department with choledocholithiasis and lap-cholecystectomy was performed. Purpose of this case report is to focus on the clinical significance of Luschka duct injury and its potential to be successfully management with endoscopic ERCP. Results: During laparoscopic cholecystectomy, an ectopic luschka duct alongside inferior border of liver in the VI segment was accidentally injured. We decide to convert to open cholecystectomy and luschka duct ligation was performed. In the 5 th PO day, bile content was detected in the patient drainage. MRCP revealed a Full-thickness maximum intensity projection showing the Luschka ducts feeding a biloma. ERCP was performed in the 6 th PO day and immediate, patient have no signs of bile content in his drainage. Patient was discharged on the 9th PO day. Conclusion: Clinical significance of Luschka ducts, lies on their risk for injury during cholecystectomy. Clinical presentation of patient with po bile leakages varies from asymptomatic to biliary peritonitis. PO identification is feasible with MRCP imaging and can be treated with less invasive techniques such as ERCP.