Conclusion
We conclude that subvesical bile duct injury may rarely present with delayed abdominal pain and fever after cholecystectomy. Avoiding deep dissection into liver parenchyma and staying close to the gallbladder can potentially avert injury to these ducts. Subvesical bile duct leaks that cannot be managed by endoscopic biliary stenting and external drains may need surgical intervention for definitive control of the bile leak.
Figures legend
Figure 1. (A) Preoperative ERCP with irregular contrast filling near the gallbladder fossa consistent with bile leak from a right posterior sectoral duct branch (solid white arrow). Cystic duct remnant (dashed arrow) is seen without any evidence of a leak. (B) Postoperative ERCP after removal of the biliary stent showing no evidence of bile leak in the gallbladder fossa.
Figure 2. Preoperative abdominal CT demonstrating biliary stent in common bile duct (A). A right upper quadrant abdominal drainage catheter is in place and terminates in the gallbladder fossa (B).