Complex biliovascular injury following cholecystectomy and its management: a case report

Introduction and importance: Bile duct injury is a serious complication of cholecystectomy, and concomitant vascular injury markedly increases morbidity and mortality. Complex vasculobiliary injuries involving both arterial and portal venous structures may cause hepatic infarction and require major reconstructive surgery. Case presentation: A 41-year-old man presented 10 days after a laparoscopic cholecystectomy that was converted to open surgery with a major combined biliary and vascular injury. Findings were consistent with a Hannover D3, d, pv injury involving hilar common hepatic duct transection, right hepatic artery injury, and main portal vein ligation and thrombosis, with infarction and abscess of the right posterior section (segments VI and VII). He underwent right posterior sectionectomy, Roux-en-Y hepaticojejunostomy, portal vein thrombectomy, and primary suture repair of the portal vein. Clinical discussion: Management of severe biliovascular injury requires accurate delineation of biliary and vascular anatomy, control of sepsis, restoration of portal inflow to the remnant liver, and secure biliary reconstruction. Conclusion: Prompt recognition upon presentation, appropriate imaging, stabilization, and carefully planned definitive surgery can salvage patients with potentially lethal complex biliovascular injuries. The patient was discharged on postoperative day 18 and remained clinically well at the final documented follow-up, 6 weeks after discharge, with a total bilirubin of 2.0 mg/dL.