A Case of Postoperative Biliary Leak in a Patient With Duplicated Cystic Ducts

TL;DR

This paper reports a rare case of a biliary leak after surgery due to duplicated cystic ducts and discusses treatment options.

Contribution

The paper adds a new clinical case to the limited literature on duplicated cystic ducts and their surgical complications.

Findings

Duplicated cystic ducts can lead to postoperative biloma formation after laparoscopic cholecystectomy.

Treatment options include ERCP, drainage, embolization, and RHYJ as a last resort.

Early identification of cystic duct anomalies is crucial to prevent complications.

Abstract

Duplicated cystic ducts are a rare congenital malformation with less than 20 reported cases before 2019. This malformation is important to identify to reduce the risk of intraoperative complications such as bile duct injuries that can increase postoperative morbidity and mortality. We present the case of a 62-year-old male with duplicated cystic ducts that were ligated during laparoscopic cholecystectomy and subsequently complicated by postoperative biloma formation. Treatment options for biliary leak include endoscopic retrograde cholangiopancreatography (ERCP) with stenting, percutaneous drainage, and duct embolization. Each carries the risk of complications such as infection, duct perforation, and stent/drain displacement. Roux-en-Y hepaticojejunostomy (RHYJ) tends to be the last resort when other minimally invasive procedures fail. It is imperative to identify postoperative complications related to cystic duct anomalies and the various treatment options available should these complications occur.

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