Vivian C. McAlister, MB; Alp Sener, MD
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McAlister VC, Sener A. Demarcated Truncal Jaundice: A Sign of Retroperitoneal Bile Leakage. Ann Intern Med. 2005;142:389. doi: 10.7326/0003-4819-142-5-200503010-00021
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Published: Ann Intern Med. 2005;142(5):389.
TO THE EDITOR:
Background: The usual treatment for abdominal collection of bile is percutaneous drainage followed by endobiliary stenting for persistent leaks (1). Delayed drainage can have severe consequences (1). Retroperitoneal bile leaks may behave differently and require different care.
Case Reports: A 43-year-old man was referred with abdominal pain and jaundice 4 days after cholecystectomy. The surgeon had difficulty dissecting the cystic duct, which retracted into the peritoneal fold when it was clipped and divided. A tube placed at the surgical site drained small quantities of serous fluid, but not bile. Skin discoloration was limited to the flanks and groin bilaterally, more marked on the right side than the left. The color of the sclera and the rest of the body, as well as the serum bilirubin level, were normal. Endoscopic retrograde cholangiography demonstrated a cystic duct bile leak. Sphincterotomy was performed, and the discoloration resolved in 4 days.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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