Biliary duct injury
Had laparoscopic cholecystectomy one week ago for cholelithiasis, presented with obstructive jaundice.
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Mild to moderate dilatation of the intrahepatic biliary ducts with an abrupt smooth cutoff at the biliary bifurcation most likely due to a ligation injury during surgery. The common bile duct appears normal in size with no stone.
At surgery, a surgical clip was found at the biliary confluence.
An iatrogenic bile duct injury involving the biliary confluence with no communication between the right and left hepatic ducts is classified type IV according to Bismuth classification or type E4 according to Strasberg classification.
Additional contributor: A. Ramdani, MD