Bile duct injury

Case contributed by Dr Ammar Haouimi

Presentation

Obstructive jaundice two weeks following laparoscopic cholecystectomy.

Patient Data

Age: 20 years
Gender: Female
MRI

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 gallbladdergastric or pancreas surgery, more frequent with laparoscopic cholecystectomy as in this case.

 

 

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