A 40 year old patient has undergone an open chlecystectomy. The procedure was reported as uneventful by the operating surgeon. She has 100 ml of bile output from the drain kept in the gallbladder bed on the first post operative day. On examination she is afebrile and anicteric. The abdomen is soft and bowel sounds are normally heard. As an attending physician. What should be your best possible advice?
Ans. is 'd' i.e. Clinical observation 100 ml. of Bile output from the patient on the 1st postop. day without any other abnormality is of no clinical significance, so does not warrant any action from the surgeon. But remember if passing of 100 ml of bile continues for 5-6 days then it is considered abnormal. It denotes bile duct injury.Oxford textbook of Surgery writes - "Even after a straightforward cholecystectomy there may be a little bile in the drain the following day."Textbook of Liver and Biliary Surgery writes - "A small amount of biliary> drainage following cholecystectomy should cause no alarm because it usually disappears within 1 or 2 days. However, excessive biliary drainage through the wound or drain site, jaundice, sepsis, or a combination of these events early in the post op. period should suggest a bile duct injury, as should copious biliary drainage for more than a few post-op days".
Order an urgent endoscopic retrograde cholangiography and biliary stenting
Urgent laparotomy
Order an urgent hepatic iminodiacetic acid scintigraphy (HIDA)
Clinical observation
Procedures - Cholecystectomy, Bile Duct Exploration, Store Extraction