Management of a complex central bile duct injury associated with laparoscopic cholecystectomy: a case report of double hepaticojejunostomy and advanced transhepatic interventional drainage technique

We describe a case of a 64-year-old obese woman with a history of severe acute cholecystitis and choledocholithias who underwent laparoscopic cholecystectomy in our clinic after endoscopic treatment by sphincterotomy and stent insertion. On the first operative day, a significant bile leakage of 400 ml appeared in the drainage. An immediate surgical revision was performed, starting by laparoscopy with conversion to open surgery. Three separate bile ducts just above the level of the biliary confluence were revealed intraoperatively. The injury was addressed by performing two separate hepaticojejunostomy anastomoses, supported by transanastomotic drains to the left sided ducts. Additionally, a percutaneous transhepatic cholangiography drain was inserted in the right hepatic duct. The postoperative course was uneventful and at postoperative day 16 the patient was discharged at home. After a follow-up of 18 months, the patient is in good condition without any signs of biliary complications. This case highlights the challenge of managing complex bile duct injuries. It emphasizes the need for multidisciplinary management in a dedicated hepato-biliary center with experienced surgeons, endoscopists, and interventional radiologists.