BACKGROUND: Cholecystectomies are common procedures that are performed daily by general surgeons alike. Energy devices although useful in reducing blood loss and providing ease with dissection planes, can be catastrophic if used to traverse the hilum of the liver.

CASE REPORT: 64-year-old male presented with a necrotic liver after an iatrogenic injury to the liver hilum during a laparoscopic cholecystectomy. On CT scan, multiple intrahepatic fluid collections and periportal edema in the right lobe of the liver, were suspicious of hepatic ischemia. The common hepatic artery had absent flow and the portal vein had severe narrowing. The patient's mental status deteriorated requiring prompt intubation and surgical exploration, which identified extensive ischemia of the right lobe and diminutive left lobe. Dissection of the hilum showed complete transection of the common bile duct, right and left hepatic arteries, and the main portal vein with an energy-based device. The patient was immediately listed as a status 1A and within 24 hours, a suitable ABO incompatible deceased liver donor was available and accepted in order to reduce the risk of further decompensation. A standard piggyback technique was utilized to implant the liver and a splenectomy was performed to reduce risk of humoral rejection. At 6 months follow up, his liver function is optimal, and he has returned to his regular lifestyle without catastrophic complications.

CONCLUSIONS: Caution and quick identification of common bile duct injuries is crucial to patient safety and liver transplantation can be utilized as the ultimate treatment for acute iatrogenic liver failure.