OCTREOTIDE AS AN ADJUNCT TO STEP-UP NONOPERATIVE MANAGEMENT OF A HIGH-OUTPUT STRASBERG TYPE C BILE DUCT INJURY AFTER LAPAROSCOPIC CHOLECYSTECTOMY: A CASE REPORT

Background: Strasberg type C bile duct injuries involve transection of an aberrant bile duct that remains open but is disconnected from the main biliary tree. This anatomical discontinuity limits the effectiveness of conventional endoscopic decompression and may result in persistent bile leakage, biloma, sepsis, and functional loss of the affected hepatic territory. Management ranges from drainage and observation to biliary reconstruction or hepatic resection. The role of somatostatin analogues in this setting remains uncertain. Case presentation: A 32-year-old man underwent laparoscopic cholecystectomy for calculous cholecystitis. Intraoperative findings were classified as Parkland grade II. A satisfactory critical view of safety was documented by anterior and posterior doublet photography, with a score of 6/6, and no bile leakage was identified. Postoperatively, the patient developed a persistent high-output bile leak of 400-600 mL/day. Endoscopic retrograde cholangiopancreatography initially suggested a leak from the middle third of the common bile duct, and a 5-Fr plastic stent was inserted without a significant reduction in output. Magnetic resonance cholangiopancreatography subsequently demonstrated a 4-mm isolated aberrant right hepatic duct without communication with the main biliary tree, with active leakage into two subhepatic bilomas, consistent with a Strasberg type C injury.