EP 279 An Atypical Post-Cholecystectomy Sequela Presenting a Diagnostic Dilemma: A Case Report
Anna Nather, John Bennett, Stavros GourgiotisAbstract
Aims
To describe an unusual postoperative sequela following complicated cholecystectomy and highlight the diagnostic challenges posed by atypical biochemical findings and evolving multi-compartment serosal effusions.
Methods
We report the clinical course, radiological findings, biochemical analysis, and multidisciplinary management of a patient who developed complex postoperative complications following conversion from laparoscopic to open cholecystectomy. Serial imaging, drain fluid analysis, microbiology, and extensive investigations were used to evaluate potential biliary, pancreatic, enteric, thoracic, and systemic causes.
Results
A 55-year-old woman with extensive prior abdominal surgery underwent elective cholecystectomy requiring conversion to open surgery with extensive adhesiolysis. Postoperatively, she developed abdominal pain, fever, and inflammation with loculated intra-abdominal collections. CT-guided drainage yielded enteric-appearing fluid with elevated amylase and low bilirubin; cultures grew polymicrobial organisms. Despite repeated contrast-enhanced imaging, no biliary, pancreatic, or enteric leak was identified, and drain amylase levels declined with conservative management. Her recovery was complicated by poor oral intake, electrolyte derangement, refeeding syndrome, hypoalbuminaemia and venous thromboses. Despite normalisation of inflammatory markers, she later developed bilateral pleural effusions progressing to a large left-sided empyema; with rapid re-accumulation post-drainage; and a concurrent circumferential pericardial effusion. Extensive investigations excluded malignancy, tuberculosis, pulmonary embolism, autoimmune disease, and primary cardiac pathology.
Conclusions
Atypical postoperative multicompartment collections with transient amylase and inconsistent microbiological findings in the absence of demonstrable visceral injury present significant diagnostic uncertainty. This case underscores the limitations of isolated biochemical and radiological findings and highlights the importance of longitudinal reassessment and integration of surgical, inflammatory, and metabolic factors in complex postoperative presentations.