Introduction
Clinically significant bile leaks complicate about 0.3–2.7% of
cholecystectomies1. Biliary tree anomalies may be
present in up to 25% of 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 sub-vesical 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
usually represent the only route of biliary drainage for the portion of
the right hepatic lobe they drain. From a surgical stand-point, the most
dangerous sectoral variant is when the CD runs alongside of a low-lying
aberrant right sectoral duct. Most commonly this is 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 sector bile duct injury
that presented as a delayed, recurrent bile leak, two and seven years
after laparoscopic cholecystectomy discussing challenges with diagnosis
and management.