Presentation
Had laparoscopic cholecystectomy one week ago for cholelithiasis, presented with obstructive jaundice.
Patient Data
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.
Case Discussion
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.
Bile duct injuries may occur after gallbladder, gastric or pancreas surgery, more frequent with laparoscopic cholecystectomy as in this case.
Additional contributor: A. Ramdani, MD