Presentation
Obstructive jaundice two weeks following laparoscopic cholecystectomy.
Patient Data
Moderate dilatation of the intrahepatic biliary ducts with an abrupt smooth cutoff 5 mm distal to the biliary bifurcation. A surgical clip artifact is seen at the same level on axial T1 and coronal FIESTA, most likely due to a ligation injury during surgery. The common bile duct shows normal size with no stone.
Note a normal anatomic variant: the right posterior hepatic duct cross over to the left, drained into the left hepatic duct also called crossover anomaly type IIIA of the variant biliary anatomy.
A small well-defined lesion is noted in segment VII with an MRI feature of a hepatic hemangioma (incidental finding).
Case Discussion
MRI features of an iatrogenic postoperative bile duct injury (confirmed at surgery), type E2 according to Strasberg classification (or type 2 according to Bismuth classification).
Bile duct injuries may be seen after gallbladder, gastric or pancreas surgery, more frequent with laparoscopic cholecystectomy as in this case.