Objective:

To present a case of intrahepatic bile duct injury (IHBDI) occurring during non-hepatobiliary surgery and to highlight the diagnostic challenges it poses.

Approach:

• Case Presentation: A 79-year-old male with a history of distal gastrectomy underwent emergency surgery for blunt abdominal trauma. Postoperatively, he exhibited gross bilious output from drains, initially suspected to be anastomotic leakage.
• Surgical Intervention: During re-laparotomy, bile extravasation was found from the liver surface, diagnosed as peripheral IHBDI, managed with direct suture ligation.

Key Findings:

• IHBDI can occur as a complication of perihepatic adhesiolysis, particularly in patients with prior abdominal surgeries.
• The injury was likely due to a combination of pre-existing biliary dilatation, occult trauma, and dissection forces during adhesiolysis.
• Successful management of IHBDI was achieved through direct suture ligation, leading to immediate resolution of bile leakage.

Interpretation:

This case highlights the diagnostic challenge IHBDI poses in non-hepatobiliary surgery and the importance of considering peripheral bile duct injury when unexplained postoperative bile leakage occurs.

Limitations:

• The rarity of IHBDI in non-hepatobiliary surgery limits generalizability.
• The case is based on a single patient experience, which may not represent broader trends.

Conclusion:

The case highlights the diagnostic challenges of IHBDI and the importance of considering it in differential diagnoses for postoperative bile leakage.