The hidden threat of uncontrollable bleeding from the gallbladder bed during laparoscopic cholecystectomy

Abstract

INTRODUCTION AND IMPORTANCE: Laparoscopic cholecystectomy is the treatment for symptomatic gallstone disease. However, a potential complication during this procedure is intraoperative bleeding resulting from vascular injuries, affecting around 0.9-1.9 % of cases. The most common bleeding site is the gallbladder bed, predominantly due to bleeding from the middle hepatic vein and its major branches. CASE PRESENTATION: This article presents an illustrative case of a superficial middle hepatic vein encountered during cholecystectomy during a donor hepatectomy. CLINICAL DISCUSSION: Safe dissection of the Calot triangle is crucial in cholecystectomy to prevent bile duct injuries. Attention is drawn to the proximity of middle hepatic vein to the gallbladder bed during dissection, which can lead to complication. Recent studies highlight significant anatomical variations, emphasizing the need for caution, especially in the patients with specific conditions. CONCLUSION: The careful surgical technique and awareness of anatomical variations, particularly regarding the proximity of the middle hepatic vein to the gallbladder bed during laparoscopic cholecystectomy. Surgeons are cautioned to maintain the focus throughout the procedure, even after achieving the critical view of safety. Preoperative evaluation of this anatomy with USS Venous Doppler and CT scan is minimize the risk of complications.