Using MR Cholangiopancreatography to Evaluate Iatrogenic Bile Duct Injury
Tahir R. Khalid1,
V. Javier Casillas1,
Berta M. Montalvo1,
Raul Centeno2 and
Joe U. Levi3
1
Department of Radiology (R-109), University of Miami School of Medicine,
Jackson Memorial Medical Center, 1611 N. W. 12th Ave., West Wing 279, Miami,
FL 33136.
2
Department of Radiology, Jackson Memorial Hospital—MRI, Diagnostic
Treatment Center, 1080 N. W. 19th St., Miami, FL 33136.
3
Department of Surgery (M-875), University of Miami School of Medicine, P. O.
Box 016310, Miami, FL 33101.
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Fig. 1. —Drawing depicts Bismuth classifications
[7,
8] of traumatic bile duct
injury. Type I is injury more than 2 cm distal to biliary bifurcation. Type II
is less than 2 cm from biliary confluence. Type III injury involves entire
common hepatic duct and leaves confluence intact. Type IV is complete or
partial destruction of biliary bifurcation.
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Fig. 2A. —Bile duct stricture at cystic duct origin in 17-year-old boy
who presented with obstructive jaundice 1 month after laparoscopic
cholecystectomy that was converted to open cholecystectomy because of
difficulty in extracting impacted cystic duct calculus. Thick-section MR
cholangiopancreatogram shows moderate intrahepatic and extrahepatic biliary
dilatation caused by short tight stricture (arrow) of common bile
duct where cystic duct origin once began. Intact distal bile duct segment is
seen.
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Fig. 2B. —Bile duct stricture at cystic duct origin in 17-year-old boy
who presented with obstructive jaundice 1 month after laparoscopic
cholecystectomy that was converted to open cholecystectomy because of
difficulty in extracting impacted cystic duct calculus. Percutaneous
transhepatic cholangiogram shows stricture (arrow) that was
balloon-dilated.
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Fig. 3A. —Excision injury with ligation in 35-year-old woman who
presented 1 week after laparoscopic cholecystectomy with right upper quadrant
pain and jaundice. Endoscopic retrograde cholangiopancreatographic image shows
distal one third of bile duct with abrupt cutoff (arrow) and multiple
surgical clips in subhepatic area.
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Fig. 3B. —Excision injury with ligation in 35-year-old woman who
presented 1 week after laparoscopic cholecystectomy with right upper quadrant
pain and jaundice. MR cholangiopancreatogram shows moderate intrahepatic
biliary dilatation and cutoff 1 cm distal to bifurcation caused by ligation
injury. Segment of extrahepatic bile duct 1.8 cm long is missing
(arrows), a finding consistent with excision injury.
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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.
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Fig. 5A. —Cystic duct leak in 62-year-old woman who presented 10 days
after open cholecystectomy with fever and jaundice. Thick-section MR
cholangiopancreatogram shows fluid collection (curved arrows)
adjacent to cystic duct remnant (straight arrow).
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Fig. 5B. —Cystic duct leak in 62-year-old woman who presented 10 days
after open cholecystectomy with fever and jaundice. Endoscopic retrograde
cholangiopancreatographic image confirms subhepatic bile leak
(arrow).
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Copyright © 2001 by the American Roentgen Ray Society.
