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Why is bile coming out from the surgery site?

Thursday, 24 December 2009
Answered by: Prof Suneet Sood
Consultant Surgeon, Malaysia
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Q. My 43 years old wife underwent an emergency surgery last week but the bile is coming out from the incision. Even after the drain tube was removed, bile continued to come out. Second surgery was preformed after 3 days but the problem is still there. She has stomach pain too. Please advise.

A.  You have not written the name of the operation done.

Emergency surgery may have been carried out for:
  1. A problem with the intestines, and
  2. A problem with the gall bladder
  1. If the surgery was carried out for the intestines, a part of the intestine was probably removed, and the rest stitched back together. If bile is coming out of the “incision”, this means that the stitched intestines have not healed. This problem is a "fecal fistula", and often occurs when surgery is required in an emergency, since the body's healing mechanisms are not optimal. At the second surgery, the surgeon may have re-done the suture, hoping to seal the leak. This second operation may not have worked again because the patient's healing is poor. In fact, the doctor should have done an "ostomy". It is difficult to explain this concept, but do ask your doctor about the "ostomy". Note that the "ostomy" operation is less easy to manage when the problem is in the first half of the intestines rather than in the second half of the intestines (as seems to be the case here). What should you do? Your relative may be in trouble here, and you must go to a centre that specializes in gastrointestinal surgery. The outcome in most small hospitals is likely to be bad.
  2. If the surgery was carried out for a gall bladder problem, the bile is probably coming from the gall bladder duct (cystic duct) or from the main bile duct. This complication is a "bile leak" and is also commoner after emergency operations. After the second operation, the leak should be coming only from the drain: this means that the leak is under control. If the leak continues to come through the incision, the patient needs further intervention (perhaps an "ERCP"). Again, this could be serious; therefore your wife must be in a specialised gastrointestinal surgery centre.

A.  You have not written the name of the operation done.

Emergency surgery may have been carried out for:
  1. A problem with the intestines, and
  2. A problem with the gall bladder
  1. If the surgery was carried out for the intestines, a part of the intestine was probably removed, and the rest stitched back together. If bile is coming out of the “incision”, this means that the stitched intestines have not healed. This problem is a "fecal fistula", and often occurs when surgery is required in an emergency, since the body's healing mechanisms are not optimal. At the second surgery, the surgeon may have re-done the suture, hoping to seal the leak. This second operation may not have worked again because the patient's healing is poor. In fact, the doctor should have done an "ostomy". It is difficult to explain this concept, but do ask your doctor about the "ostomy". Note that the "ostomy" operation is less easy to manage when the problem is in the first half of the intestines rather than in the second half of the intestines (as seems to be the case here). What should you do? Your relative may be in trouble here, and you must go to a centre that specializes in gastrointestinal surgery. The outcome in most small hospitals is likely to be bad.
  2. If the surgery was carried out for a gall bladder problem, the bile is probably coming from the gall bladder duct (cystic duct) or from the main bile duct. This complication is a "bile leak" and is also commoner after emergency operations. After the second operation, the leak should be coming only from the drain: this means that the leak is under control. If the leak continues to come through the incision, the patient needs further intervention (perhaps an "ERCP"). Again, this could be serious; therefore your wife must be in a specialised gastrointestinal surgery centre.

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