Our trysts with the Duct of Luschka – A case series with Review of Literature

Abstract

Postoperative bile leaks are a surgeon’s worst nightmare. One of the rare causes is iatrogenic injury to the duct of Luschka (DOL). This anatomical variant is very rare, it is even rarer to detect its presence pre-operatively due to its small size & peculiar location. Therefore, most of the times, it is incidentally detected on table. In such patients, it is carefully safeguarded. Unfortunately, when present, it is also iatrogenically injured often by the unsuspecting surgeon. After iatrogenic injury, there are two scenarios. The first is when the injury is detected on table and subsequently promptly immediately repaired surgically. This avoids postoperative bile leak, formation of bilioma and peritonitis which would then mandate another endoscopic / surgical intervention, in the early postoperative period. The second more dangerous scenario is when the intra-operative iatrogenic injury goes unnoticed. This typically happens due to the fact that it is a very small calibre duct which does not necessarily start leaking bile immediately. Herein, the authors share their experience of encounters with the DOL. The purpose of this case series is to highlight this rare albeit potentially trouble making condition and to add to the literature on this subject. Also, the intention is to drive home the important point that surgeons should carefully and elaborately look for an injury to the DOL. This would increase the chances of intra-operative detection of the same, thereby preventing another surgical intervention, at a later date.