Injury to duodenum and common bile duct is a potentially life-threatening complication of endoscopic retrograde cholangiography (ERC) and sphincterotomy. Here we report, segment 3 bile duct of liver during therapeutic ERC, that we diagnosed by peroperative trans-cystic cholangiogram. This was successfully managed by CBD exploration, duct repair and T tube drainage. A 28-year female with antecedent  history of intermittent biliary colic for one year and jaundice for 7 days, she evaluated in local centre with ultrasonography abdomen which revealed cholelithiasis with choledocholithiasis for that she underwent ERCP which was unsuccessful to retrieved the stone, post ERCP she started upper abdomen pain which was associated with fever, frequent vomiting and multiorgan failure, in view of perforation peritonitis she underwent exploratory laparotomy, Lavage and air cholangiogram via cystic duct after cholecystectomy which revealed bile leak from segment 3 duct on liver surface which was managed with CBD exploration, T-tube drainage and repair of bile leak on liver surface with prolene 3-0.  Patient tolerated oral sips on 1st postoperative day and discharge on second postoperative day, he has no complained or sequel at 3,6,12 months in postoperative follow up. As number of endoscopic intervention increased for hepatobiliary diseases the unusual hepatobiliary sites injury also occurs and these injury easily missed, so that high degree of suspicion is paramount important for diagnosis and successful treatment.

Keywords: Post ERCP bile duct injury, Choledocholithiasis, Bile duct injury.

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Ashok Kumar

SGPGIMS, India