Background: Bile duct injury (BDI) remains a severe and technically challenging complication of open and laparoscopic cholecystectomy. While a primary Roux-en-Y hepaticojejunostomy (RYHJ) is the gold-standard treatment, early anastomotic dehiscence is a catastrophic event associated with profound sepsis, tissue friability, and high mortality. This case report highlights the critical role of a staged surgical approach using temporary external biliary drainage as a bridge to a definitive, successful re-do biliary-enteric reconstruction.

Case Description: A patient presented to our tertiary care center with generalized biliary peritonitis and sepsis following an open cholecystectomy complicated by a major, high- grade bile duct injury (Strasberg Type E2). A primary Roux-en-Y hepaticojejunostomy was initially performed. However, on postoperative day 8, the patient deteriorated rapidly due to complete anastomotic dehiscence and an uncontrolled bile leak. Given the severe local inflammation, tissue edema, and systemic sepsis, immediate re-anastomosis was deemed unsafe. The patient underwent emergency exploration, extensive peritoneal debridement, and placement of a external biliary drainage to convert an uncontrolled leak into a controlled external fistula. Following a meticulous nutritional optimization, antibiotic therapy, and resolution of local inflammation, a definitive re-do hepaticojejunostomy was successfully performed. The postoperative course was uneventful, liver function tests normalized, and the patient was discharged in excellent clinical condition.

Conclusion: When a primary biliary reconstruction fails acutely, immediate re-anastomosis in an infected, edematous field is highly prone to recurrent failure. A staged strategy prioritizing external biliary drainage, sepsis control, and deferred definitive revision is an elegant, safe, and highly effective salvage paradigm.

KEYWORDS: Bile Duct Injury, Cholecystectomy Complications, Hepaticojejunostomy Failure, Anastomotic Dehiscence, External Biliary Drainage, Re-do Hepaticojejunostomy.