Jiaxin Lu, Shaoqiong Cheng, Hongfei He, Zhijuan Gao, Hua Zhong, Tongxin Liu, Xinghua Peng
A 37-year-old woman underwent laparoscopic bailout subtotal cholecystectomy at a county hospital on December 20, 2025, for acute cholecystitis with cholelithiasis. Dense Calot's triangle adhesions prevented safe ductal exposure. Suspected cystic-duct impaction prevented intraoperative cholangioscopic entry; the remnant was sutured (no clip/stapler documented), and no formal intraoperative cholangiography was performed. MRCP showed a long, low-inserting cystic duct, a 6-mm confluence calculus and upstream biliary dilatation. Tissue friability and persistent obstruction may have contributed to the subsequent leak.