Objective:
Although laparoscopic cholecystectomy (LC) is considered the gold standard treatment for symptomatic gallstone disease, iatrogenic bile duct injury remains a rare but serious complication. We present a case of Strasberg type D bile duct injury that was diagnosed intraoperatively and successfully managed with endoscopic retrograde cholangiopancreatography (ERCP) during the same session, and we discuss it in light of the current literature.

Case:
A 46-year-old female patient underwent LC for a hydropic and edematous gallbladder. During difficult dissection, a bile leak was observed from the posterior wall of the common hepatic duct, consistent with a Strasberg type D injury. The endoscopy team was consulted intraoperatively, and ERCP was performed. Cholangiography confirmed the leak, and a plastic stent was placed from the common hepatic duct to the ampulla. The operation was completed with drainage of the subhepatic area. Postoperatively, the patient remained clinically stable. At the sixth postoperative week, follow-up ERCP revealed complete healing with no evidence of leakage, and the stent was removed. The patient had an uneventful recovery, with normal biochemical parameters on follow-up.

Conclusion:
Early recognition of iatrogenic bile duct injury is the most critical factor influencing prognosis. The literature reports intraoperative detection rates between 25% and 32%, whereas delayed diagnosis is associated with higher morbidity, additional surgical interventions, and prolonged hospital stay. Endoscopic management, particularly in Strasberg type C and type D injuries where ductal continuity is preserved, has shown high success rates (89–96%) and represents a reliable alternative to surgery. This case highlights that multidisciplinary collaboration and intraoperative endoscopic intervention provide a minimally invasive and effective option for the management of bile duct injuries during LC.

Keywords: Laparoscopic cholecystectomy, Strasberg type D, bile duct injury, ERCP, intraoperative management

Laparoskopik Kolesistektomi Sýrasýnda Geliþen Ýatrojenik Koledok Yaralanmasýnýn Ýntraoperatif Tanýsý ve Endoskopik Tedavisi: Bir Olgu Sunumu

Amaç:
Laparoskopik kolesistektomi (LK), semptomatik safra taþý hastalýðýnýn tedavisinde altýn standart olarak kabul edilse de, iatrojenik safra yolu yaralanmalarý nadir fakat ciddi komplikasyonlar arasýnda yer almaktadýr. Bu çalýþmada, Strasberg Tip D koledok yaralanmasýnýn intraoperatif tanýsý ve ayný seansta endoskopik retrograd kolanjiyopankreatografi (ERCP) ile baþarýlý tedavisi sunulmakta ve literatür eþliðinde tartýþýlmaktadýr.

Olgu:
Kýrk altý yaþýndaki kadýn hasta, hidropik ve ödemli safra kesesi nedeniyle LK’ye alýndý. Zorlu disseksiyon sýrasýnda ana hepatik kanalýn posterior duvarýnda safra kaçaðý izlendi ve Strasberg Tip D yaralanma tanýmlandý. Ýntraoperatif dönemde endoskopi ekibi çaðrýlarak ERCP uygulandý. Kolanjiografide kaçak doðrulandý ve hepatik kanaldan ampullaya plastik stent yerleþtirildi. Operasyon tamamlanarak subhepatik alana dren kondu. Postoperatif dönemde hasta stabil seyir gösterdi. Altýncý haftada yapýlan kontrol ERCP’de kaçaðýn tamamen iyileþtiði görüldü ve stent çýkarýldý. Takiplerde komplikasyon geliþmedi ve biyokimyasal parametreler normal seyretti.

Sonuç:
Ýatrojenik safra yolu yaralanmalarýnýn erken tanýnmasý hasta prognozunu doðrudan etkileyen en kritik faktördür. Literatürde intraoperatif taný oranlarýnýn %25–32 arasýnda olduðu bildirilmekte, gecikmiþ taný ise daha yüksek morbidite, ek cerrahi giriþimler ve uzamýþ hastanede kalýþ süreleriyle iliþkilendirilmektedir. Özellikle Strasberg Tip C ve Tip D yaralanmalarda endoskopik tedavi, kontinuitenin korunduðu durumlarda yüksek baþarý oranlarý (%89–96) ile güvenilir bir seçenektir. Bu olgu, multidisipliner yaklaþýmýn ve intraoperatif endoskopik müdahalenin, safra yolu yaralanmalarýnýn yönetiminde cerrahiye alternatif, minimal invaziv ve etkili bir yöntem sunduðunu göstermektedir.

Anahtar Kelimeler: Laparoskopik kolesistektomi, Strasberg Tip D, safra yolu yaralanmasý, ERCP, intraoperatif yönetim