Fatal liver failure due to retroperitoneal hemorrhage in elective laparoscopic cholecystectomy—a case report

Postoperative complications following elective laparoscopic cholecystectomy are rare but can have serious clinical consequences. Major complications include bleeding, bile duct injury, bile leakage, as well as bowel and vascular injuries. This case describes a 68-year-old patient in whom elective laparoscopic cholecystectomy was complicated by bile leakage and fatal retroperitoneal hemorrhage. Computed tomography was performed due to postoperative abdominal pain and revealed both intraperitoneal and retroperitoneal fluid. Diagnostic laparoscopy identified free intraperitoneal bile without active signs of bile leakage. Endoscopic retrograde cholangiopancreatography showed no evidence of bile leakage or choledocholithiasis. Computed tomography was obtained due to acute liver failure and demonstrated increased retroperitoneal fluid causing compression of the pancreatic head, duodenum, inferior vena cava, and porta hepatis. Anatomical variations of the hepatic arterial vasculature were also observed. The patient deceased due to multi-organ failure. Autopsy revealed massive retroperitoneal hemorrhage.