Acute suppurative cholecystitis complicated by middle hepatic vein thrombosis: a case report.

Hepatic vein thrombosis is a rare and severe complication of acute cholecystitis. Preoperative diagnosis is challenging, and surgical management requires meticulous planning. A 63-year-old asymptomatic male was admitted for elective inguinal hernia repair. Preoperative computed tomography incidentally revealed gallstones with wall thickening and a suspected hepatic vein thrombus. He was transferred for hepatobiliary consultation. Subsequent magnetic resonance imaging confirmed cholecystitis with middle hepatic vein thrombosis. He underwent open cholecystectomy with adhesiolysis and partial colectomy due to dense inflammatory adhesion. Intraoperative frozen section ruled out malignancy. The patient recovered well after a postoperative course of antibiotics and was discharged on Day 19. This case highlights that acute cholecystitis can progress to complicated hepatic vein thrombosis even in asymptomatic patients. Preoperative imaging is critical for diagnosis and surgical planning. Early surgical intervention following oncological principles (R0 resection) is recommended when malignancy cannot be excluded, even if final pathology is benign.