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Value of MR Cholangiography in Patients with Iatrogenic Bile Duct Injury After Cholecystectomy

Alfonso Ragozzino1, Rosaria De Ritis1, Alessandro Mosca2, Vittorio Iaccarino3 and Massimo Imbriaco1,3

1 Department of Radiology, Cardarelli Hospital, Via Pansini 5, Via Manzoni 214/0, Naples 80123, Italy.
2 Department of Gastroenterology, Cardarelli Hospital, Naples 80123, Italy.
3 Department of Radiology, University Federico II, Naples, Italy.



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  		Fig. 1. —39-year-old man with Bismuth type I injury [9] 1 week after laparoscopic cholecystectomy. MR cholangiogram shows stricture (arrow) at level of common hepatic duct more than 2 cm from biliary confluence. Patient was treated with hepaticojejunostomy.

 


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  		Fig. 2. —41-year-old woman with Bismuth type III injury [9] 8 days after laparoscopic cholecystectomy. MR cholangiogram shows stricture (arrow) at level of common hepatic duct, leaving biliary confluence intact. Patient was treated with hepaticojejunostomy.

 


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  		Fig. 3A. —63-year-old man with Bismuth type IV injury [9] 10 days after laparoscopic cholecystectomy. MR cholangiogram (A) and maximum-intensity-projection image (B) show stricture at level of common hepatic duct with extension and partial destruction of biliary confluence (arrows). Patient was treated with hepaticojejunostomy.

 


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  		Fig. 3B. —63-year-old man with Bismuth type IV injury [9] 10 days after laparoscopic cholecystectomy. MR cholangiogram (A) and maximum-intensity-projection image (B) show stricture at level of common hepatic duct with extension and partial destruction of biliary confluence (arrows). Patient was treated with hepaticojejunostomy.

 


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  		Fig. 4A. —54-year-old woman with Bismuth type V injury [9] 12 days after laparoscopic cholecystectomy. T-tube cholangiogram shows only distal part of biliary tree with no visualization of common hepatic duct or of intrahepatic biliary tracts.

 


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  		Fig. 4B. —54-year-old woman with Bismuth type V injury [9] 12 days after laparoscopic cholecystectomy. MR cholangiogram shows stricture at level of right posterolateral duct (short arrow) with associated involvement of common hepatic duct (long arrow). Patient was treated with hepaticojejunostomy.

 


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  		Fig. 5A. —75-year-old woman with bile leak from cystic duct remnant 1 week after laparoscopic cholecystectomy. Coronal fat-suppressed T2-weighted image shows small collection adjacent to cystic duct remnant (arrow).

 


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  		Fig. 5B. —75-year-old woman with bile leak from cystic duct remnant 1 week after laparoscopic cholecystectomy. Coronal volumetric maximum-intensity-projection mangafodipir trisodium–enhanced image confirms extravasation of contrast material into subhepatic space (arrow). Patient was treated with percutaneous drainage.

 

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