A patient underwent laparoscopic cholecystectomy and was discharged on the same day. On postoperative day 3, he presented to the hospital with fever. Ultra-sonography showed a 5 x 5 cm collection in the right sub diaphragmatic region. What will be the manage!ment?
Observe with antibiotic cover
Re-explore the wound with T-tube inseion
Pigtail inseion and drainage
ERCP and proceed
Answer- C. Pigtail inseion and drainageThis patienl is most likely having a biliary leak from the cystic duct stump, which has formed a large 5 x 5 cm collection.Such a patient needs to be managed with intravenous antibiotics as well as drainage of the collections (as it acts as source of injection). Ultrasound guided pigtail inseion is the easiest method to obtain adequate drainage of the bile leak.