Unusual subcapsular hepatic collection of pancreatic enzymes following laparoscopic cholecystectomy for biliary pancreatitis: a rare case report
DOI:
https://doi.org/10.5281/zenodo.17955017Keywords:
Biliary pancreatitis, Hepatic subcapsular collection, pancreatic enzyme leak, laparoscopic cholecystectomy, percutaneous drainageAbstract
Background: Hepatic subcapsular collections are uncommon after laparoscopic cholecystectomy, and when they occur, they are almost always biliary in origin. Collections rich in pancreatic enzymes without biliary leakage are extremely rare.
Case Presentation: We report the case of a 54-year-old man with diabetes mellitus and hypertension who presented with acute biliary pancreatitis. After clinical stabilization, he underwent an uneventful laparoscopic cholecystectomy. On postoperative day 4, he developed abdominal pain, with recurrent elevation of serum amylase and lipase. Contrast-enhanced CT revealed large right and left hepatic subcapsular collections. Percutaneous drainage showed fluid with markedly elevated pancreatic enzyme levels but normal bilirubin, pointing to a pancreatic origin. MRCP and surgical review did not demonstrate any fistulous tract between the pancreas, biliary tree, or liver. The patient was treated conservatively with percutaneous drainage and supportive care; the collections regressed gradually, and he was discharged in good condition.
Conclusion: This case underscores a rare and unexpected postoperative complication in a patient with biliary pancreatitis undergoing cholecystectomy. Clinicians should consider pancreatic enzyme leakage as a possible etiology of hepatic subcapsular collections, even without demonstrable fistula. Early recognition, fluid analysis, and drainage may suffice without requiring surgical intervention.
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Copyright (c) 2025 Sameh Zahran, Alyaa Aldokhi, Amal Qayed (Author)
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