A 75 year old male with no prior medical illness presented with upper gastrointestinal bleeding (UGIB) which was confirmed endoscopically and histologically to be a result of a periampullary adenocarcinoma. computed tomography (CT) abdomen revealed a periampullary mass. Staging laparoscopy revealed multiple bilobar liver lesions which excluded the option of curative surgery. Intraoperatively, the transverse colon was noted to be adhered to segment 4B of the liver and upon release of the adhered loop, bile leak was seen from the liver parenchyma. The affected segment was sutured which arrested further emanation of bile. Two days later patient underwent a laparoscopic washout for suspected bile peritonitis. An attempt of on table endoscopic retrograde cholangiopancreatography (ERCP) failed due to papilla inaccessibility. We proceeded with an endoscopic ultrasound-guided choledochoduodenostomy (EUS CDS). With the linear echoendoscope in long position, a 19G needle was punctured into the dilated proximal portion of the CBD. Bile was aspirated to confirm its position and a 0.025 visiglide wire was then advanced into the intrahepatic ducts. The tract was dilated with an 8F cystotome followed by deployment of a 10 x 60 mm self-expandable fully covered metal stent under fluoroscopic guidance. After four days the abdominal drain was removed and the patient was discharged. At the third month follow-up clinic review, patient was well with no evidence of stent migration. To the best of our knowledge this is the first reported case of an EUS CDS approach being utilized in a case of post-operative bile leak.