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Post-cholecystectomy bile leak — ESEGH MCQ

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HardPancreatico-biliary DiseasePost-cholecystectomy bile leakESEGH

A 66-year-old woman has persistent right upper quadrant pain 2 weeks after laparoscopic cholecystectomy. She is febrile and CT shows a subhepatic fluid collection. Bilirubin is 42 micromol/L and ALP is 320 IU/L. HIDA scan suggests bile leak from the cystic duct stump. What is the most appropriate management?

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Correct answer: E — ERCP stenting plus drainage of the biloma

The best answer is “ERCP stenting plus drainage of the biloma”. ERCP with biliary stent placement and drainage of the collection The alternatives “Observation without antibiotics or drainage”, “Immediate Whipple procedure, when clinically appropriate”, “Oral cholestyramine alone, after specialist review”, “Colonoscopy with clipping, within a guideline-based pathway” are plausible in related gastroenterology presentations but do not match the defining finding, threshold, sequence or UK pathway in this stem.

Reference: NICE NG85 pancreatic cancer recommendations: https://www.nice.org.uk/guidance/ng85/chapter/Recommendations