Endoscopic repair of Strasberg type D bile duct injury following laparoscopic cholecystectomy: an unconventional approach.

Background and Aims: Bile duct injury (BDI) is a rare but serious adverse event of laparoscopic cholecystectomy (LC). Prompt diagnosis using imaging and endoscopic tools is essential. Although most minor BDIs (Strasberg types A-C) might be managed with ERCP, major injuries (types D and E) typically require surgical intervention. This case highlights an unconventional approach in which a Strasberg type D injury was successfully managed with ERCP alone. Methods: We present a case of Strasberg type D BDI following ERCP with plastic stent placement for Mirizzi's syndrome. One day later, during LC, common bile duct (CBD) injury occurred with the stent seen intraoperatively. Results: ERCP was repeated, and a guidewire was advanced through the ampulla to reconnect the transected CBD. A bridging stent restored bile flow. MRCP confirmed no leak, and CT at 4 weeks showed complete resolution of the biloma. The patient missed ERCP follow-up for bile leak and stricture evaluation. Conclusions: This case challenges current guidelines recommending hepaticojejunostomy for major BDIs within 72 hours, suggesting ERCP may offer a nonsurgical alternative in select cases. MRCP may serve as a valuable tool for confirming repair success and guiding postprocedural assessment in such nonoperative management approaches.