Roux-en-Y Hepaticojejunostomy for Iatrogenic Bile Duct Injury (Strasberg E1): A Case Report and Review of the Surgical Technique

Iatrogenic bile duct injury (IBDI) is a severe complication of cholecystectomy that requires systematic management to avoid long-term morbidity and mortality.We report the case of a 47-year-old female who sustained a Strasberg E1 bile duct disruption following a cholecystectomy performed 15 days prior.Initial stabilization and biliary decompression were achieved via ultrasound/fluoroscopy-guided percutaneous transhepatic biliary drainage (PTBD).Following resolution of hyperbilirubinemia and targeted antibiotic therapy for multidrug-resistant biliary colonizers (Escherichia coli extended-spectrum beta-lactamase (ESBL) and Enterococcus faecalis), the patient underwent definitive open Roux-en-Y hepaticojejunostomy (Hepp-Couinaud technique) with a transanastomotic biliary catheter.Postoperative recovery was uneventful, demonstrating normalization of liver function and successful biliary drainage.This case underscores the value of a multidisciplinary step-up approach, adequate infection control, and adherence to surgical principles in achieving optimal outcomes in complex biliary injuries.