On postoperative day 2 after laparoscopic cholecystectomy, a patient develops increasing abdominal pain and bilious drainage from a port site. Ultrasound shows a small subhepatic collection. Cholangiography via ERCP shows extravasation at the cystic duct stump with a normal common bile duct. What is the most appropriate management?
- A Immediate relaparotomy and repair over a T-tube
- B ERCP with biliary sphincterotomy and placement of a plastic stent across the papilla ✓
- C Percutaneous transhepatic biliary drainage alone
- D Hepaticojejunostomy
Correct answer: B. ERCP with biliary sphincterotomy and placement of a plastic stent across the papilla
Explanation
A cystic duct stump leak with an otherwise intact biliary tree is managed endoscopically: sphincterotomy with a transpapillary stent lowers intrabiliary pressure and diverts bile flow away from the leak, allowing it to seal in most patients. Relaparotomy and reconstruction are reserved for major duct injuries with discontinuity, where ERCP stenting fails. Percutaneous drainage alone drains collections but does not close the leak, and hepaticojejunostomy is excessive here.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.