PMID- 34466328
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20210903
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 13
IP  - 7
DP  - 2021 Jul
TI  - Spontaneous Bile Leak in a Patient Without Recent Abdominal Surgery or Trauma.
PG  - e16702
LID - 10.7759/cureus.16702 [doi]
LID - e16702
AB  - Bile leaks are a rare occurrence most often seen as a complication of 
      cholecystectomy. Other less common etiologies include endoscopic retrograde 
      cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC), 
      liver surgery, percutaneous drainage of liver abscesses, living donor 
      hepatectomy, and non-iatrogenic abdominal trauma. In this case study, we present 
      a 67-year-old female with morbid obesity who presented with abdominal pain and 
      was diagnosed with a spontaneous bile leak. She had no history of recent surgery 
      or abdominal trauma. CT revealed that the patient's gallbladder was located in 
      the right lower quadrant, most likely due to mass effect from a large ventral 
      hernia, and possible fluid collection extending from the gallbladder along the 
      surface of the anterior inferior right hepatic lobe. Hepatobiliary iminodiacetic 
      acid (HIDA) was performed due to a concern for cholecystitis. HIDA demonstrated a 
      bile leak in the right upper abdomen of unknown etiology. Initially, there was a 
      concern for gallbladder obstruction. Gastroenterology recommended magnetic 
      resonance cholangiopancreatography (MRCP), however, MRCP was not possible due to 
      the patient's body habitus. The patient had normal liver function tests, was 
      tolerating oral intake, and her abdominal pain resolved, therefore, we became 
      less suspicious of gallbladder obstruction. This case suggests that bile leak 
      should be included in the differential diagnosis for abdominal pain even in 
      patients who have not had recent abdominal surgery or procedures. This case also 
      highlights the unique anatomical finding of a right lower quadrant gallbladder 
      secondary to mass effect from a large ventral hernia.
CI  - Copyright (c) 2021, Micheli et al.
FAU - Micheli, Daniel
AU  - Micheli D
AD  - Family and Community Medicine, Western Michigan University Homer Stryker School 
      of Medicine, Kalamazoo, USA.
FAU - Patel, Keshav R
AU  - Patel KR
AD  - Internal Medicine, Western Michigan University Homer Stryker School of Medicine, 
      Kalamazoo, USA.
FAU - Li, Tong
AU  - Li T
AD  - Family and Community Medicine, Western Michigan University Homer Stryker School 
      of Medicine, Kalamazoo, USA.
FAU - Kassir, Mahmoud
AU  - Kassir M
AD  - Family and Community Medicine, Western Michigan University Homer Stryker School 
      of Medicine, Kalamazoo, USA.
FAU - Eichorn, Wesley
AU  - Eichorn W
AD  - Family and Community Medicine, Western Michigan University Homer Stryker School 
      of Medicine, Kalamazoo, USA.
LA  - eng
PT  - Case Reports
DEP - 20210728
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC8397512
OTO - NOTNLM
OT  - abdominal pain
OT  - bile duct injury
OT  - biliary tree
OT  - spontaneous bile leak
OT  - ventral hernia
COIS- The authors have declared that no competing interests exist.
EDAT- 2021/09/02 06:00
MHDA- 2021/09/02 06:01
PMCR- 2021/07/28
CRDT- 2021/09/01 07:24
PHST- 2021/07/28 00:00 [accepted]
PHST- 2021/09/01 07:24 [entrez]
PHST- 2021/09/02 06:00 [pubmed]
PHST- 2021/09/02 06:01 [medline]
PHST- 2021/07/28 00:00 [pmc-release]
AID - 10.7759/cureus.16702 [doi]
PST - epublish
SO  - Cureus. 2021 Jul 28;13(7):e16702. doi: 10.7759/cureus.16702. eCollection 2021 
      Jul.