Presentation
Recent history of technically difficult laparoscopic cholecystectomy. Abdominal pain and fever. Elevated bilirubin levels.
Patient Data
Peritoneal fluid collection is observed surrounding the lower third of the common bile duct and in the perihepatic recesses. It is also seen extending through the foramen of Winslow (epiploic foramen) and filling the lesser sac.
The biliary tree is not dilated.
Right side abdominal wall edema. Right side peritoneal drainage catheter.
Case Discussion
This is a case of bile duct injury following a technically difficult laparoscopic cholecystectomy with bile leakage into the peritoneal cavity passing from the greater sac of the peritoneum to the lesser sac through the foramen of Winslow (epiploic foramen) demonstrating its anatomical relations.
Boundaries of the foramen of Winslow
anterior: the free edge of the lesser omentum (hepatoduodenal ligament) which contains the common bile duct, hepatic artery proper, and portal vein between its two layers
posterior: peritoneum covering the inferior vena cava
superior: peritoneum covering the caudate lobe of the liver
inferior: peritoneum covering the commencement of the duodenum (D1) and the hepatic artery proper, the latter passing forward below the foramen before ascending between the two layers of the lesser omentum
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