Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, South Korea.
Medicine (Baltimore). 2021 Nov 19;100(46):e27877. doi: 10.1097/MD.0000000000027877.
Bile peritonitis is one of the rare complications that can occur after cholecystectomy or hepatectomy. It is associated with high mortality, prolonged hospital stay, and increased cost. We herein report 2 cases of bile leakage as a postoperative complication of right hemicolectomy.
Two patients underwent a right hemicolectomy for colon cancer. Both patients had a history of cholecystectomy, and intrahepatic bile duct dilatation was observed in preoperative imaging study. During surgery, adhesiolysis was performed between the liver and the hepatic flexure of the colon due to adhesion in that area.
Postoperatively, bile fluid was drained via an intraabdominal drainage tube. Both cases required surgical intervention to explore the origin of the leakage. In both cases, the anastomosis was intact, and the injury of the intrahepatic bile duct just beneath the liver surface was the origin of bile leakage.
Suture ligation, irrigation, and drainage were performed in both patients.
There was no more bile leakage after reoperation, and both patients were discharged in good health after antibiotics treatment.
Although very rare, bile leakage due to intrahepatic duct injury can occur after right hemicolectomy in patients with a history of cholecystectomy and intrahepatic duct dilatation. It is necessary to consider the possibility of bile duct injury and anastomotic leakage if bile leakage is suspected after right hemicolectomy.
胆漏是胆囊切除或肝切除术后可能发生的罕见并发症之一。它与高死亡率、住院时间延长和成本增加有关。本文报告了 2 例右半结肠切除术后胆漏的病例。
两名患者因结肠癌行右半结肠切除术。两名患者均有胆囊切除术史，术前影像学检查显示肝内胆管扩张。手术中，由于该区域粘连，在肝与结肠肝曲之间进行了粘连松解。
术后通过腹腔引流管引流胆汁。两种情况均需要手术干预以探查漏出的来源。在两种情况下，吻合口均完整，肝表面下的肝内胆管损伤是胆漏的原因。
对两名患者均进行了缝合结扎、冲洗和引流。
再次手术后无胆汁漏出，两名患者在抗生素治疗后均健康出院。
尽管非常罕见，但对于有胆囊切除术和肝内胆管扩张史的患者，右半结肠切除术后可能会发生肝内胆管损伤导致的胆漏。如果怀疑右半结肠切除术后发生胆漏，有必要考虑胆管损伤和吻合口漏的可能性。
