Combined endoscopic and surgical management of a right intrahepatic bile duct injury during laparoscopic cholecystectomy

Biliary tract wounds are a rare complication of cholecystectomy [1]. They lead to the appearance of intra- or extrahepatic biliary stenosis, which usually requires endoscopic treatment [2] [3] [4]. They occur mainly when inflammation persists after cholecystitis or angiocholitis. The direct connection of the right posterior bile duct to the common hepatic duct is a well-known anatomical variant of the biliary tract, which can lead to the sectioning of the right posterior bile duct during cholecystectomy [1]. We report here the case of a 70-year-old woman who underwent laparoscopic cholecystectomy following acute cholecystitis. During the procedure, bile flow was found after sectioning of the cystic duct. Intraoperative opacification of the biliary tract showed it being in fact the right posterior bile duct. At the same time, an endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy was performed. After biliary wound catheterization, the guidewire was introduced inside the right posterior bile ducts laparoscopically ([Fig. 1]). A 7 Fr × 15 cm plastic biliary stent was then placed under endoscopic, fluoroscopic, and laparoscopic guidance inside the right posterior bile ducts to aid healing of the bile duct ([Video 1]).