A 35 year old woman was referred to Digestive Surgery Clinic with abdominal sepsis following a cholecystectomy on her 11th postoperative day.

CT picked up a large collection of bile in the upper abdomen. A pigtail catheter was introduced radiologically along with antibiotics. Owing to residual sepsis, a laparoscopic drainage was undertaken subsequently, following which she recovered rapidly. A controlled biliary fistula developed that persisted for a month.

MRCP showed dilated left and right hepatic ducts and a block at the confluence of ducts. No vascular injury was identified.

A definitive repair of the bile duct in the form of left hepaticojejunostomy was done.

The link below shows the critical steps of the procedure that is vital to good long term outcome.