Isolated XXXX : a diagnostic and therapeutic challenge.

@entity1 @entity834 @entity384 @entity1157 @entity158 @entity253 @entity99 @entity255
Biliary leaks and injuries are not an uncommon occurrence following laparoscopic cholecystectomy. @entity1157 associated with the biliary anatomic variant of a low-inserting right segmental hepatic duct can be particularly difficult to diagnose in that results of endoscopic retrograde cholangiography (ERC) are usually interpreted as "normal" with no leaks demonstrated. The aim of this study was to describe a single institution's experience with nine @entity1 with biliary leaks associated with this anatomic variant and to discuss their management. A retrospective analysis of the hospital records of all @entity1 with @entity1157 managed at a single institution between 1980 and July 1998, inclusive, was performed. Nine @entity1 were identified as having an isolated @entity99 associated with a biliary leak. Seven (78%) of the nine @entity1 had undergone a laparoscopic cholecystectomy, whereas the remaining two @entity1 (22%) had undergone an open cholecystectomy. All of the @entity1 had undergone endoscopic retrograde cholangiography at outside institutions, the results of which had been interpreted as normal with no apparent leaks. The median interval from the time of cholecystectomy to referral was 1.4 months. All @entity1 were managed with initial percutaneous access of the involved @entity253 , with placement of a percutaneous transhepatic stent. After the biliary leak was controlled, all @entity1 underwent Roux-en-Y hepaticojejunostomy to the isolated biliary segment. All @entity1 had an uncomplicated postoperative course. There were no postoperative @entity834 . Postoperative stenting was maintained for a mean of 8 months. Six (67%) of the nine @entity1 had a long-term successful outcome with minimal or no symptoms. In three @entity1 , recurrent symptoms with @entity158 and/or @entity255 developed at a mean of 34 months. All three @entity1 underwent percutaneous cholangiography, which demonstrated an anastomotic stricture, and all were managed with percutaneous @entity384 with a successful outcome. Currently eight (89%) of the nine @entity1 are asymptomatic, with a mean follow-up of 70.4 months (range 12 to 226 months). One @entity1 had intermittent right upper @entity158 with normal liver function tests but has not required intervention. Isolated @entity99 with biliary leakage is an uncommon complication following laparoscopic cholecystectomy. A diagnostic dilemma is created by the presence of a @entity1157 with a normal endoscopic retrograde cholangiogram. Management begins with percutaneous access of the transected isolated ductal system followed by reconstruction as a Roux-en-Y hepaticojejunostomy.
