About … Postprocedural abdominal pain led to a computed tomography (CT)3 scan which confirmed ascites. Dropped gallstones leading to abscess formation can occur after a period of months to years after the laparoscopic cholecystectomy, which can make diagnosis challenging . RJJackson
After laparoscopic gallbladder removal, 53 patients were randomized to have a suction drain positioned in the subhepatic space and 53 patients to have a sham drain. Biliary LeakBiliary Leak Leaks from the cystic duct stumpLeaks from the cystic duct stump unrecognized duct of Luschkaunrecognized duct of Luschka.. Bile leaks commonly present shortly after cholecystectomyBile leaks commonly present shortly after cholecystectomy ((within 1 weekwithin 1 week)) with right upper quadrant pain, fever, chills, and hyperbilirubinemiawith right upper quadrant … The following factors correlated with a worse outcome: length of time bile was left in the abdomen and the development of superinfection. Surgeons must watch for the clinical manifestations of bile ascites after laparoscopic cholecystectomy. The patient was in a good clinical condition and did not mention any complaints. Br J Surg. Bile peritonitis, as used herein, does not imply that the bile was infected. Once the presence of intra-abdominal fluid has been confirmed by CT scan, the fluid should be percutaneously drained and cultured while the patient is still in the scanner. The longer the bile collections were left undrained, the greater the incidence of severe illness, including sepsis. Crowley
1973 Oct;137(4):613-7 Fluid collection is a common postoperative finding, and most fluid collections are asymptomatic and absorbed by the peritoneum. :'( :'( In less than a week after I had gall bladder removal,I had had a low fever.I went in to the surgeon at the end of the week,he drained fluid;in another week,again.He seems upset/his nurse is extremely rude;and again,I am having A VERY HARD TIME.I c Cholangitis developed in 25% of patients with these other serious complications. Role of intraperitoneal drains on subhepatic collection following routine uncomplicated cholecystectomy. Our data show that the symptoms caused by bile collections were often quite subtle. Therefore, a negative HIDA scan was unreliable, and a positive scan required the alternative study anyway. B Bile ascites. The other 154 (86%) did not initially have drains placed and developed abdominal bile collections. Small fluid collections were identified in the gallbladder fossa in 56 patients (53.0%). This technique is the most common for . Because there is risk of miscommunication unless words are used in the same way, we defined them precisely in the article. reported a postoperative subhepatic fluid collection in 25.5% of patients after conventional cholecystectomy . Design
In 23 (13%) cases, the injury was recognized at the index operation. The clinical syndromes caused by bile collections in the abdomen span a wide spectrum and their natural history and risks are not fully appreciated. First, could you tell us about the specific complications that occurred in those patients who did have infected bile, and second, what recommendations could you make for management in patients who had drains placed? Drain output was minimal, and blood tests showed rising leucocytosis and inflammatory markers. 2013 Feb;75(1):22-7. doi: 10.1007/s12262-012-0452-5. Fluid collection was detected in the gallbladder area in 67 patients (26.8%). In a study of 130 patients, Kong et al. Routine Sub-hepatic Drainage versus No Drainage after Laparoscopic Cholecystectomy: Open, Randomized, Clinical Trial. They indicate that suspicion should be raised when a patient is not doing well after a cholecystectomy, demonstrating anorexia, abdominal distention suggesting an ileus, and fever. Indian J Surg. An abdominal CT scan should be obtained in patients who have a syndrome suggestive of bile ascites, especially after laparoscopic cholecystectomy. Bilirubin levels rise because of reabsorption of bilirubin from the abdomen. Elboim CM, Goldman L, Hann L, Palestrant AM, Silen W. A prospective ultrasound study of the right upper quadrant in 105 patients who had undergone cholecystectomy showed the incidence of fluid collection in the gall bladder fossa to be 24% 2 to 4 days after operation. It is observed that the rate of clinically-relevant bile leaks after conventional open cholecystectomy ranges was between 0.1% and 0.5% 1-3). The sensitivity of percutaneous transhepatic cholangiography for detecting abnormalities was 100%, and for ERCP, 98%. Post cholecystectomy syndrome is a condition that is acquired after an operative procedure, cholecystectomy. BWright
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