A novel pattern of complex bile duct injury characterized by distal ligation and proximal perforation: temporary T-tube drainage as a bridge to definitive reconstruction-a case report and literature review

Bile duct injury (BDI) is a serious complication of cholecystectomy. We report a previously unrecognized pattern of complex BDI in a 30-year-old man who presented one week after open cholecystectomy with biliary peritonitis. Endoscopic retrograde cholangiopancreatography demonstrated an abrupt common bile duct (CBD) cutoff, while magnetic resonance cholangiopancreatography revealed a biloma with features suggestive of biliary peritonitis. Exploratory laparotomy confirmed distal CBD ligation with proximal common hepatic duct perforation. Because of severe inflammation and friable tissues, definitive reconstruction was deferred, and temporary T-tube drainage was established. The T-tube was maintained for ~3 months before removal. The established tract remained temporarily patent after removal, permitting transient bile drainage during progressive fibrosis and closure. The patient was closely monitored clinically, with serial liver function tests and ultrasonography. After adequate biliary-tree dilatation, Roux-en-Y hepaticojejunostomy was performed. At 2-year follow-up, he remained asymptomatic without recurrent biliary complications.