What is a Postoperative Bile Leak?

Mary McMahon
Mary McMahon

A postoperative bile leak is a potential complication of cholecystectomy procedures, where the gallbladder is removed. This complication occurs in less than two percent of laparoscopic cholecystectomy cases, and is usually identified after the surgery, when the patient is in recovery. Treatment involves draining the leak and addressing the cause. It can often be accomplished without taking the patient back into surgery, although the patient will need to be placed under sedation for comfort.

Symptoms of a bile leak may include abdominal pain and nausea.
Symptoms of a bile leak may include abdominal pain and nausea.

Postoperative bile leaks can have a number of causes. One of the most common is a retained bile stone. The stone causes pressure to build up, and can lead to ruptures at the surgical site, allowing bile to leak out. Another potential cause is an injury to the major bile duct. These injuries are often not noticed at the time they occur unless they are significant. In both cases, the patient develops symptoms like nausea, decreased appetite, and abdominal pain after surgery.

A cholecystectomy is done to remove the gallbladder.
A cholecystectomy is done to remove the gallbladder.

A procedure known as endoscopic retrograde cholangiopancreatography can be used to inject tracer dyes to follow the movement of bile visually on a medical imaging study. This procedure will show the leak and provide information about the precise location and size. Repair procedures may be possible through the stents inserted during this procedure, allowing a doctor to address the postoperative bile leak quickly and with minimal stress for the patient, before complications like infection develop as a result of the leak.

A postoperative bile leak is a complication of less than two percent of laparoscopic cholecystectomy cases.
A postoperative bile leak is a complication of less than two percent of laparoscopic cholecystectomy cases.

Developing a postoperative bile leak is not a sign that a surgeon was incompetent or careless. This complication is rare and has been documented in a wide variety of cases, including cases performed by highly experienced and very attentive situations. Care is taken during surgery to avoid any common causes of bile leaks and patients are monitored after surgery to catch leaks early, in the event they develop, as they are a known risk of procedures involving the gallbladder and liver.

Patients who have had cholecystectomy surgeries and notice symptoms like abdominal pain and nausea should report the symptoms as quickly as possible to a nurse or doctor if they are in the hospital. If the patient has been sent home, the surgeon should be called to discuss the symptoms. If there are concerns that the symptoms are indicative of a bile leak, the patient will be asked to undergo some tests to confirm the leak and then will be provided with information about available treatment options.

Located underneath the liver, the gallbladder stores and concentrates bile produced by the liver.
Located underneath the liver, the gallbladder stores and concentrates bile produced by the liver.
Mary McMahon
Mary McMahon

Ever since she began contributing to the site several years ago, Mary has embraced the exciting challenge of being a wiseGEEK researcher and writer. Mary has a liberal arts degree from Goddard College and spends her free time reading, cooking, and exploring the great outdoors.

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Discussion Comments

anon1004080

I had my gallbladder removed in 2018, and about 10 months later began to suffer horrific panic attacks. It took me a while to puzzle why and how, but the severity and frequency of he attacks made imperative that I persevere and eventually I reconstructed what must have happened.

When the surgeon removed the gallbladder, s/he (I am not sure which) he must have severed the bile duct, but omitted to fully push it back into the abdomen, with its clip, or the clip came off altogether and the duct got trapped. I cannot be sure which.

Fact is, I discovered that there is a hormone, called choleocystokinin, which is a hormone that helps the digestion of fat and protein.

So, I have reconstructed that the CCk hormone is leaking into the exit wound, seeping into my capillary blood vessels, causing these horrific attacks of pure, unadulterated terror, that last, intermittently, throughout a day.

What helped me seal my self-diagnosis is the fact that, as the wound healed - forming a keloid scar - the duct was squeezed almost shut, and the attacks went from hourly or more frequent to only on occasions where i eat an excess of saturated fats.

This stimulates secretion of CCK that seeps into the capillaries surrounding the trapped bile duct, and enters into circulation. The symptoms persist around 24 hours and I have not found a way of neutralizing them.

Naturally the medical profession refuses to acknowledge this process, probably afraid that I would sue for compensation - I have no intention of suing the NHS!

I thought I would share this, in case there should be some who experience the same phenomenon and think they are going crazy.

anon998798

When I had my bile leakage it felt like I was getting punched in the stomach area. It was worst pain I've ever had. My doctor tried to say it was just a backache. I went to another hospital and the leak was discovered. I stayed in the hospital for about a week. I had a stent placed while in the hospital. I had to have the stent removed after a couple of months.

anon996129

I had a bile leakage which was repaired after five days. It's been eight weeks and I have terrible muscle aches in both arms and total skeletal inflammation and am continuing on 1000 mg of nabumetone per day.

Anyone else?

anon978333

I also had a bile leak. The days after my surgery I noticed I wasn't getting any better. I couldn't eat. My stomach looked like I was nine months pregnant. Finally, a week after the surgery, my husband called an ambulance because he could not even help me to my feet. The pain was so bad.

We went to the emergency room. After several tests, they admitted me. The next day they put in a tube to drain the bile. I had so much relief from this procedure, but still a lot of pain. Two days later, they put in a stent. I am home now and it has been five weeks since the surgery. I am tired, but the doctors say I have been through a lot.

I go back in three weeks to have the stent taken out. Hopefully, there will be no more leaks. If it is still leaking, I will have to have another stent. Sometimes it takes more than one stent. I am on the road to recovery!

anon941124

My Mom had surgery for a bleeding duodenal ulcer a month ago. Her JP drain continues to fill up with green fluid (bile). Her surgeon said the leak will eventually close with proper nutrition. I am just worried because it is more than a month now and the volume has not decreased.

anon329471

Based on my experience, having a bile leak six days post surgery, you will absolutely you are having a major problem as compared to normal recovery.

I have chronic migraines, so I am used to dealing with pain. This was beyond! My son had to call an ambulance and I was hospitalized for two weeks. It took three surgical procedures to get my leak under control as it was "stubborn." Fun times. However, these situations, from what I've been told and read, are extremely rare! I know do many people who have done perfectly well with gallbladder surgery. Just be sure, if you are concerned about something, do not let the medical professionals put you off. Best wishes!

anon328468

I had a bile leak. It took a week and lots of tests to find it and that was the longest week of my life! I assume everyone has different experiences, but the pain was worse then a kidney stone, labor, or having three C-sections.

Mine started has a heartburn feeling, but it went around to my back. About a day later, it went to attacks of pain. During the attacks I couldn't breathe and sweat poured. It could last 10 minutes or an hour.

I got three shots of morphine in about 30 minutes and it didn't ease anything. When the HIDA showed the leak, late that night a stent was put in. The next morning, I had surgery again to clean the bile out and had two JP drains put in. I wore one drain for three weeks. I'll need another surgery to remove the stent.

anon254481

I had a bile leak after having my gallbladder removed. I was in a severe amount of pain after the surgery, but just thought it was from the surgery. The major site of the pain was around my kidney.

The pain continued for a weeks, so I finally went to the ER. Of course, they couldn't find anything. It took a doctor ordering a scan called a hida scan (sp)?, to notice the leak. I had the ERCP done. Unfortunately, the damage to my body was already so bad that I developed acute hemorrhagic pancreatitis. I had to be opened up completely and cleaned out.

I'm not trying to scare you. Just saying that if you do suddenly notice severe pain after having the surgery, say something immediately.

manykitties2

@drtroubles - I had my gallbladder out when I was in my early twenties due to bad diet and a family history of similar issues. I was one of the unlucky ones that had postoperative bile leak and honestly it wasn't that bad. I didn't even know about mine because the doctor spotted it first. I guess they wheeled me right back into surgery and fixed it. It was just a note on my medical chart my mom spotted while snooping about.

I think you'll be fine with your gallbladder surgery. Almost everyone in my family has had it, and besides the issue I had they have all been perfectly fine afterwards. The recovery period is a bit painful, but nothing medication doesn't help.

drtroubles

Having your gallbladder removed is a pretty common surgery but I didn't know until recently that a postoperative bile leak was a possibility until I spotted it on a list of complications that could result from this surgery.

Has anyone ever experienced a postoperative bile leak? Did you notice it first or did the doctor?

I am a bit worried about my own upcoming cholecystectomy surgery and worry that I won't be able to discern normal discomforts after surgery from something more serious. I am prepared to be really sore for a while, but am not sure about additional complications. Perhaps I am just worrying a bit too much.

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