Bile leak from accessory duct(s) of Luschka post cholecystectomy
RUQ pain ~ 48 hours post laparoscopic cholecystectomy, ? bile leak
CT cholangiogram post intravenous infusion 100ml Biliscopin
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Normal filling of the biliary tree with leak of contrast from the gall bladder fossa in the region of the cystic duct clips but no contrast in the cystic duct stump (arrow). No choledocholithiasis. Note a small duct filling with contrast that passes from the right hepatic duct towards the gall bladder fossa - this could well be an accessory duct of Luschka.
Bile leak is infrequently seen post cholecystectomy, usually from the cystic duct stump, consequent to increased pressure from distal bile duct obstruction or inadequate clipping of the cystic duct. Occasionally the leak is not from the stump but from a small accessory duct or ducts of Luschka that pass from an intra-hepatic ductal branch directly into the gall bladder lumen. They are usually of little clinical significance apart from in the post-cholecystectomy patient leading to bile leak. These leaks are usually self-limiting.
The key to this case is the finding of contrast leak without filling of the cystic duct stump meaning contrast is exiting from an alternative source.