World Journal of Laparoscopic Surgery

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VOLUME 17 , ISSUE 1 ( January-April, 2024 ) > List of Articles


Waltman Walter Syndrome—A Rare Postcholecystectomy Presentation: A Case Report

Lingam Sridhar, Rohit Phadnis, Faiz Hussain, Subrahmanya Narayan Dora Kurumella, Sarath Chandra Chappidi, Sindhu Singareddy

Keywords : Bile leak, Case report, Cystic duct stump leak, Endoscopic retrograde cholangiopancreatography, Laparoscopic cholecystectomy, Postlaparoscopic cholecystectomy complication, Subdiaphragmatic collection

Citation Information : Sridhar L, Phadnis R, Hussain F, Kurumella SN, Chappidi SC, Singareddy S. Waltman Walter Syndrome—A Rare Postcholecystectomy Presentation: A Case Report. World J Lap Surg 2024; 17 (1):58-60.

DOI: 10.5005/jp-journals-10033-1603

License: CC BY-NC 4.0

Published Online: 14-02-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Waltman Walter syndrome after laparoscopic cholecystectomy (LC) is rarely reported. However, it needs to be recognized promptly and managed as otherwise it can lead to further metabolic and infective complications. We present the case of a 42-year-old male who was admitted with ultrasound-proven cholelithiasis with no signs of cholecystitis and with a history of acute calculous cholecystitis. His total leukocytic count (TLC) and liver function tests (LFTs) were within normal limits. He underwent an uneventful LC with drain placement in Morrison's pouch. Postoperatively, he had complaints of pain in the abdomen and fever, clinically icterus was present, tachycardia and multiple fever spikes with persistent hypotension, and ultrasonography (USG) abdomen was suggestive of fluid collection of 214 cc noted tracking along the subdiaphragmatic region extending into the gallbladder fossa. Endoscopic retrograde cholangiopancreatography (ERCP) was done and was suggestive of a cystic stump leak for which biliary duct sphincterotomy + common bile duct (CBD) stenting was done. An USG-guided aspiration was done and bilious fluid was aspirated from subdiaphragmatic region. On postoperative day (POD) 10, the patients improved symptomatically, with a normal LFT, and the drain was removed; on follow-up after 4 weeks, he had no complaints, and stent removal was done. The main “take-home” message is that although rare, Waltman Walter syndrome is an unusual and rarely reported complication of post-LC particularly postdrain placement due to accumulation of bile in the subdiaphragmatic region. Timely response in diagnosing and bile drainage helps in the prevention of mortality and morbidity.

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