Intraoperative diagnosis and endoscopic management of iatrogenic common bile duct injury during laparoscopic cholecystectomy: A case report.

Although laparoscopic cholecystectomy (LC) is considered the gold standard treatment for symptomatic gallstone disease, iatrogenic bile duct injury remains a rare but serious complication. We present a case of a Strasberg type D bile duct injury that was diagnosed intraoperatively and successfully managed with endoscopic retrograde cholangiopancreatography (ERCP) during the same session, and we discuss it in light of the current literature. A 46-year-old female patient underwent LC for a hydropic and edematous gallbladder. During difficult dissection, a bile leak was observed from the posterior wall of the common hepatic duct, consistent with a Strasberg type D injury. The endoscopy team was consulted intraoperatively, and ERCP was performed. Cholangiography confirmed the leak, and a plastic stent was placed from the common hepatic duct to the ampulla. The operation was completed with drainage of the subhe-patic area. Postoperatively, the patient remained clinically stable. At the sixth postoperative week, follow-up ERCP revealed complete healing with no evidence of leakage, and the stent was removed. The patient had an uneventful recovery, with normal biochemical parameters on follow-up. Early recognition of iatrogenic bile duct injury is the most critical factor influencing prognosis. The literature reports intraoperative detection rates between 25% and 32%, whereas delayed diagnosis is associated with higher morbidity, additional surgical interventions, and prolonged hospital stay. Endoscopic management, particularly in Strasberg type C and type D injuries where ductal continuity is preserved, has shown high success rates (89-96%) and represents a reliable alternative to surgery. This case high-lights that multidisciplinary collaboration and intraoperative endoscopic intervention provide a minimally invasive and effective option for the management of bile duct injuries during LC.