Case Report: Intrahepatic bile duct injury during adhesiolysis mimicking anastomotic leak

Intrahepatic bile duct injury (IHBDI) is a rare but serious postoperative complication, typically associated with hepatobiliary procedures or direct hepatic trauma. We present the case of a 79-year-old male with prior distal gastrectomy and Billroth II reconstruction who underwent emergency gastrointestinal surgery following blunt abdominal trauma. Postoperatively, gross bilious output from surgical drains raised concern for anastomotic leakage; however, re-laparotomy revealed bile extravasation from the segment 3 liver surface, consistent with peripheral IHBDI most plausibly arising from a combination of pre-existing peripheral biliary dilatation, occult traumatic injury, and the dissection forces applied during perihepatic adhesiolysis. The injury was successfully managed with direct suture ligation, leading to immediate resolution of bile leakage and complete recovery. This case underscores the diagnostic challenge IHBDI poses in non-hepatobiliary surgery and emphasizes the importance of considering peripheral bile duct injury when unexplained postoperative bile leakage occurs in patients with prior abdominal surgeries.