Delayed Bile Leak Presenting One Week after Laparoscopic Cholecystectomy due to Biliary Ascariasis: A Case Report with Review of Literature

Abstract

Mohammad Ali, Shivram Singh Yadav and Hazique Jameel

Background: Bile leak is a recognized but uncommon complication of laparoscopic cholecystectomy, with an incidence ranging between 0.3% and 2%. Most cases occur within a few days post-operatively; however, delayed presentation beyond one week is rare and can be diagnostically challenging.

Case Presentation: We present a case of a 28-year-old female who developed upper abdominal pain and low-grade fever one week following laparoscopic cholecystectomy. Ultrasound revealed a localized subhepatic fluid collection. Patient underwent USG-guided pigtail insertion in the subhepatic space and peri-splenic space. MRCP revealed mild beaking of postoperative fluid towards the cystic duct remnant region, likely a bile leak originating from the cystic duct stump. The patient underwent ERCP for stenting, and incidentally, a worm was seen in the CBD. The patient was managed successfully with ERCP-guided CBD stenting and worm removal from the CBD.

Conclusion: Delayed bile leak, though uncommon, should be suspected in any patient presenting with abdominal pain and distension of the abdomen. Early imaging and a minimally invasive management strategy can prevent serious morbidity.

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