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The introduction of laparoscopic chole− cystectomy was associated with an in− creased rate of biliary complications such as leakages and strictures [1]. While most of these can be successfully treated endo− scopically or with percutaneous transhe− patic biliary drainage (PTBD) [2,3], com− plete dissection of the common bile duct requires surgical repair in virtually all cases [4]. We report here the case of a 31− year−old man who presented 3 days after laparoscopic cholecystectomy with cho− lestasis (alkaline phosphatase 476 U/l, normal range 40 ± 129; bilirubin 8.4 mg/ dl £ 1.2). Endoscopic retrograde cholangi− ography showed complete blockage of contrast in the distal part of the common bile duct (Figure 1), which was not tra− versable with various guide wires. PTBD was therefore carried out, showing dilat− ed intrahepatic bile ducts and complete ductal obstruction of the common hepatic duct, representing the proximal end of a complete dissection (Figure 2). The dis− tance between the two obstructed ducts was estimated to be 1.5 cm, with clips being visible in the area. The PTBD proce− dure was terminated with the insertion of a pigtail prosthesis for drainage, and the patient was referred for surgery.

Percutaneous Transhepatically Assisted Surgical Repair of a Complete Bile Duct Dissection Due to Laparoscopic Cholecystectomy