Management of Middle Hepatic Vein Injury during Laparoscopic Cholecystectomy: A Case Report

Background  Cholecystectomy continues to be the first choice for the treatment of symptomatic cholelithiasis. Especially in patients with acute cholecystitis, a laparoscopic approach has become the standard treatment option. Intraoperative complications of laparoscopic cholecystectomy include: bile duct injury, organ damage, and bleeding due to vascular injury. Difficult hemorrhage during laparoscopic cholecystectomy occurs in 0.1 to 1.9% of all cases. Besides major vessel injuries, gallbladder bed vasculature is reported as a common injury site, mostly secondary to middle hepatic vein lesions. Case Presentation  We present a case report of a patient taken for a laparoscopic cholecystectomy. During the procedure, inadvertent middle hepatic vein injury occurs. Here we describe the management approach selected for this type of injury. Discussion  We recommend careful dissection during the final steps of a laparoscopic cholecystectomy. Following cystic duct and cystic artery ligation, surgeons often inappropriately relax through the last part of the dissection. During this final dissection, if care is not taken, small vascular structures can be missed and injured.