Suggest treatment for bile leakage post cholecystectomy

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Posted on Wed, 17 Jun 2015 in Digestion and Bowels
Question: Had a lap cholecystectomy last monday 2 weeks ago. Had bad abd cramping and rigid abdomen the following g Tuesdays evening g, went to ER where I had surgery we'd morning and was admitted observation. Thursday morning couldn't take the pain anymore told nursing staff to tell the Dr something was really wrong (I'm a nurse at the facility I was at) they did a hb scan since my CT scan just showed irrigation solution in my abd the day before in ER (COME TO FIND OUT IT WAS BILE THE WHOLE TIME) and had a bile leak from go knew where at that time bc the surgeon was clueless. Got transferred after and unsuccessful ERCP at the local hsp. So I went to AGH last Thursday evening, they were waiting for me when I got there. Decided pain management until morning when a specific surgeon could be there at 7am sat morning, monitored vitals and cbc q2 - 4 hrs thru the evening. So Friday went for ERCP met surgeon before OR and he stated I needed to see a surgeon right away for vile peritonitis due to my appearance and abdominal assessment. So he did the ERCP I spiked a temp during end of procedure and had a consult with surgeon once I was out of recovery. She did an abd wash and inserted two Jp drains. I started feeling better since Friday slowly, and have had only clear yellowish thin drainage into my drains. Until today started feeling extra fatigued abdominal muscles sore thought maybe I did to much up and down yesterday. I just went to the bathroom and noticed a pulling pinching sensation around my umbilical area and just said oh and palates and felt nothing different externally. Other than some increase in muscular abd pain and that feeling by my umbilical area I noticed that I think I'm jaundice again. Don't know what to do and don't want to let it go if I should seek emergency medical care, I write everything off being a nurse but having bile peritonitis the last time I wrote off belly pain as gas pain, I just don't wanna die due to complications r/t sepsis or something I could of been a better nurse about.
doctor
Answered by Dr. T Chandrakant 3 hours later
Brief Answer:
Proper drainage - wait and watch- maintain best Hb and Albumin in blood

Detailed Answer:
Hi.
Read and understood the history from surgery till now.
It is for sure that there is a bile peritonitis due to leakage of the bile post-Cholecystectomy and it is 2 weeks now.
- First ERCP was attempted and was unsuccessful.
- Could they pin-point the area/ spot from where the bile is leaking and pass a stent past the perforation site in the second ERCP or not?
Are the JP drains functioning well and draining ?
Are you at home or in the Hospital or at Home?

I can understand the plight you must be going through.
The proper treatment must have already been already being done.

The mainstay of the treatment is:
- Drainage of the bile out of peritoneal cavity.
- Drainage of the bile through the stent in the CBD in the duodenum
- Proper hydration and electrolyte balance.
- Finding the site of leakage.

The proper drainage is the key.
Once the site is known of the leakage, it is decided whether further surgery will be required to correct the defect or will heal on its own.

You may understand what I mean by (as you are the nurse): the dictum is if the distal passage is clear, the fistula heals on its own.

Many times wait and watch policy is best adapted in such cases as emergency surgery to close/bypass the defect may not be successful as the tissues are friable and do not hold the sutures.

In the meantime see that your hemoglobin and serum proteins, particularly the albumin have to be maintained the best to have the best healing possible.

I hope this answer helps you, please feel free to ask further relevant queries or if you feel that there is a gap-of-communication.
I shall be happy to support/assist you in your best recovery possible.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant 38 minutes later
Was dx with bile peritonitis last friday, then did an ercp due to a bile leak from lap chole I had done monday. The surgeon doing the lap chole missed that I had a ductus of luschka so when he removed my gallbladder bile began to drain into my abdomen. Didn't habe any s/s of complications until Wed morning. Any way bile leak was corrected with ercp and 2 jp drains and abd wash last friday. That's why it's concerning me that I'm yet again "yellow". Have been home since Tuesday drains are still in and have only put out moderate amounts of serous drainage with no chane.
doctor
Answered by Dr. T Chandrakant 4 hours later
Brief Answer:
Wait and watch, you shall be fine soon.

Detailed Answer:
Hi.
Thanks for your feedback.
As you may know the duct of Luschka also called as subvesical duct may not be identifiable in most of the cases, and it is thought to be a hard luck for every one.
But the best part is most of the patients with Sphincterotomy, Bile duct stent and intra-abdominal drain respond well and the duct of Luschka will heal up on its own.

So do not worry, follow the path given by your Surgeon and you will be fine.
The peritoneum has a very large absorption surface and the bile leaked into it will eventually be absorbed by through it hence increasing yellowness and nothing much to worry if the other parameters are getting better.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. T Chandrakant

General Surgeon

Practicing since :1984

Answered : 17967 Questions

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