Post-Operative Complications of the Cholecystectomy in an Underweight Patient: Case Report, Review of Literature & a Word of Caution

Abstract

Introduction: This is a case report of an underweight patient in whom sub-total cholecystectomy was followed by persistent leakage of bile. Aims: To review the cholecystectomy and correlate with BMI and post-operative risks. Methods: USG (Ultrasonograph) abdomen revealed choledocholithiasis causing proximal dilatation of the CBD (common biliary duct) and the IHBR (Intra Hepatic Biliary Radicals). Choledocholithiasis with upstream biliary dilatation and Cholethiasis with few calculi in dilated cystic duct.  Laparoscopic cholecystectomy was performed. Results: Post-operative complications developed with biliary leakage, fever, edema, vomiting and diarrhea. Perforation with hypo-dense collection in peritoneal cavity was observed. She had generalized edema, tachycardia and bilious output from abdominal invasion site and drain. Patient was only managed conservatively and discharged. Conclusion: This case demonstrates that underweight patients need to be evaluated thoroughly before surgery to treat the complications of cholecystectomy in order to steer clear of an operation which carries high-risk. The information and recommendations are being presented in the essence of research and enhancing safety of the patient. Clinicians are reassured to deliberate this case with their surgical teams and exercise caution when planning a surgery for an underweight patient.