A 40 year old patient has undergone an open cholecystectomy. The procedure was repoed as uneventful by the surgeon. She has 100ml of bile output from the drain kept in the gallbladder bed on the first postoperative day. On examination she is afebrile and anicteric. The abdomen is soft and bowel sounds are normally heard. As an attending surgical resident, what should be your advice?
A minimal amount of bile leakage persists for a day or two following cholecystectomy. It does not require any intervention as long as the bile leak is less than 500 ml and it decreases gradually. Any bile leak persisting for more than three postoperative days or more than 500 ml requires investigation. Causes : Common bile duct injury Slippage of knots off the cystic duct stump Injury to intrahepatic biliary duct during dissection of gall bladder of liver bed
Order an urgent endoscopic retrograde cholangiography and biliary stenting
Urgent laparotomy
Order an urgent hepatic iminodiacetic acid scintigraphy (H1DA)
Clinical observation