• Tuan Huu Ly, Quang Tien Pham, Loc Huynh Tran, Ha Nhat Tran, Phuoc Duy Tran, Khoa Hoang Anh Nguyen, Truc Huynh Thanh Le, and Trung Quoc Pham.
• Department of Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam.
• Medicine (Baltimore). 2024 Aug 16; 103 (33): e39283e39283.

RationaleComplications after endoscopic retrograde cholangiopancreatography (ERCP) are diverse and usually treated with nonoperative management or percutaneous drainage; however, there are still some rare, life-threatening complications. This is an extremely rare case of biliary peritonitis caused by rupture of the intrahepatic bile duct after ERCP.Patient ConcernsA 63-year-old male underwent ERCP for common bile duct stones. On the second day after the procedure, the patient developed sepsis and abdominal distention. Contrast-enhanced computed tomography revealed a subcapsular hepatic fluid collection attached to the bile duct of segment VII.DiagnosesSepsis resulted in liver parenchyma rupture and intrahepatic bile duct injury after ERCP. Intraoperative cholangiography revealed a connection between a hole in the liver parenchymal surface and the intrahepatic bile duct.InterventionsSurgeons performed the cholecystectomy, inserted a T-tube into the common bile duct stones, sutured the defect, and put 2 drainage tubes around the lesion.OutcomesPostoperative recovery was uneventful, and the patient was discharged on the 17th postoperative day.LessonsIntrahepatic bile duct perforation after ERCP can lead to rupture of the liver parenchyma, biloma, or abdominal peritonitis. Multidisciplinary management is necessary to achieve favorable outcomes.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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