Biloma and Biliary Fistula Secondary to Strasberg E2 Bile Duct Injury After Open Cholecystectomy: Case Report

Introduction: Iatrogenic bile duct injury (BDI) remains one of the most catastrophic complications in gastrointestinal surgery, with profound implications for patient morbidity, long-term survival, and healthcare costs. Its incidence is significantly exacerbated by severe local inflammation and anatomical variations. Case Presentation: A 40-year-old male with a history of type 2 diabetes and prior orchidectomy for testicular cancer presented with complicated cholecystitis. He underwent an open cholecystectomy at an external facility where a Strasberg E2 BDI occurred due to distorted anatomy from Mirizzi Syndrome and piocolecystitis. The patient developed a high-output biliary fistula (500–600 cc/day) and a perihepatic biloma. Upon referral to a tertiary care center, magnetic resonance cholangiopancreatography (MRCP) confirmed a complete interruption of the common hepatic duct. A definitive surgical reconstruction via a Roux-en-Y hepaticojejunostomy was performed. Discussion: Strasberg E2 injuries involve the common hepatic duct more than 2 cm from the confluence. Successful management hinges on early recognition, control of sepsis, and specialized biliary reconstruction to prevent secondary biliary cirrhosis and recurrent cholangitis. Conclusion: This case highlights the necessity of a multidisciplinary approach and the critical role of advanced imaging in planning definitive repairs in specialized hepatobiliary units.