The duct of Luschka is a normal variant that drains bile directly from the liver parenchyma into the gallbladder. It typically is located on the posterior gallbladder wall and is injured or unrecognized in .04% to 0.2% of cholecystectomies (gallbladder removal.)
It most commonly presents 1 week after gallbladder resection with nausea, vomiting, and abdominal pain from the freely draining bile into the abdominal cavity.
ERCP is performed for suspected duct of Luschka injuries as the test is both diagnostic and therapeutic. If the leak is considered low-grade, sphincterotomy is performed and is successful in closing the leak about 90% of the time. For high-grade leaks (i.e., leaks that present relatively earlier in the post-operative course) stenting is used with virtually all leaks closing.
In the unusual situation where the leak does not close, the treatment of choice is then percutaneous transhepatic cholangiography (PTC.)
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