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Postoperative Cholestasis After Uncomplicated Laparoscopic Cholecystectomy: A Case Report
1Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA, mountsinai.org.
Introduction:
In the absence of complications, transient jaundice has been observed in postoperative patients after abdominal surgery. This jaundice has been previously attributed to intrahepatic cholestasis due to oxidative stress from surgery and can be marked within the first postoperative weeks. However, this change has often been seen in patients with significant comorbidities. This report describes the case of a young, healthy patient who developed severe postoperative jaundice after a routine laparoscopic cholecystectomy with no evidence of biliary injury or obstruction, leading to endoscopic retrograde pancreatography and severe necrotizing pancreatitis.
Case Presentation:
A 45-year-old male with no medical comorbidities presented to our hospital with signs and symptoms consistent with acute cholecystitis. He promptly underwent an uncomplicated laparoscopic cholecystectomy with routine intraoperative cholangiogram (IOC) that was unrevealing. He represented on postoperative day two to the emergency department with a severe conjugated hyperbilirubinemia with unremarkable cross-sectional imaging. He subsequently underwent endoscopic retrograde pancreatography without evidence of biliary obstruction or biliary leak, after which his hyperbilirubinemia resolved without any further intervention over the following days. As a result of the endoscopic retrograde pancreatography, he developed a complicated case of necrotizing pancreatitis, with a course including multiple operative interventions.
Conclusion:
In patients with severe postoperative jaundice, postoperative intrahepatic cholestasis should be considered on the differential in the absence of evidence of other surgical complication. Surgeons should be aware of potential benign causes of hyperbilirubinemia. After laparoscopic cholecystectomy, many important complications are diagnosed and treated with endoscopic retrograde pancreatography. Given its associated potential morbidity, pursuing biliary imaging should be a consideration.
