Introduction
Clinically significant bile leaks complicate about 0.3–2.7% of cholecystectomies1. Biliary tree anomalies may be present in up to 25% of the patient population and aberrant right hepatic ducts are the most common2. While a majority of bile leaks originate from the cystic duct (CD) stump or the subvesical duct of Luschka1, those from aberrant sectoral bile ducts are rarely discussed.
Aberrant sectoral duct arises most commonly from the right liver segments and drain into the common hepatic duct (CHD) or CD. These ducts can represent the only route of biliary drainage for the portion of the right hepatic lobe they drain. From a surgical stand-point, the most clinically relevant sectoral variant to consider is when the CD runs alongside a low-lying aberrant right sectoral duct, most commonly the right posterior sectoral duct (RPSD), which drains segments 6 and 7. It is present in 4.8–8.4% of the population2. Injuries to these ducts are likely underreported since they may be asymptomatic and often unrecognized as the injured area atrophies over time.
We present an unusual case of right posterior sectoral bile duct injury that presented as a delayed, recurrent bile leak, two and seven years after laparoscopic cholecystectomy discussing challenges with diagnosis and management.