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Fig. 4. —Transection of multiple intrahepatic ducts in 47-year-old woman who presented 1 day after laparoscopic cholecystectomy and failed choledocholithotomy on dilated proximal bile duct. Oblique coronal thick-section MR cholangiopancreatogram shows "absence of biliary confluence" (arrow), a finding consistent with disruption of intrahepatic ducts at and proximal to bifurcation (Bismuth type IV injury). Surgical exploration confirmed four ducts separately ending at porta hepatis as seen in this image.