Bile Leak 30 Years Post-cholecystectomy: A Rare Case.

Bile leaks are a well-recognised complication of cholecystectomy, typically presenting within the first postoperative week. Extremely delayed presentations are exceptionally rare, with only a handful of cases reported years after the index procedure. We report the case of a 60-year-old woman who presented with a four-day history of epigastric pain, fever, and vomiting, 30 years following open cholecystectomy. Imaging revealed a subhepatic fluid collection and a dilated common bile duct suggestive of a biliary leak. She was successfully managed with ultrasound-guided percutaneous drainage and intravenous antibiotics, without the need for endoscopic retrograde cholangiopancreatography, and made an uneventful recovery. This case represents one of the longest documented intervals between cholecystectomy and bile leak presentation, highlighting that biliary causes of intra-abdominal sepsis should not be excluded irrespective of the time elapsed since surgery, and reinforcing the importance of lifelong clinical vigilance following cholecystectomy.