A 68-year-old man presents with progressive jaundice and CT showing a hilar biliary stricture. MRCP confirms a hilar cholangiocarcinoma with involvement of the left hepatic duct confluence extending to secondary radicals on the right. Left portal vein is occluded. Using Bismuth-Corlette classification, this is most accurately classified as:

• A Type II — involves the confluence
• B Type IIIa — extends into right secondary intrahepatic ducts
• C Type IIIb — extends into left secondary intrahepatic ducts with portal vein involvement ✓
• D Type IV — extends into both right and left secondary intrahepatic ducts

Explanation

Bismuth-Corlette classification: Type I = below confluence; Type II = at confluence; Type IIIa = extends into right secondary hepatic ducts; Type IIIb = extends into left secondary hepatic ducts; Type IV = extends into both sides. This patient has stricture involving the confluence extending to secondary radicals on the RIGHT with LEFT portal vein occlusion. The description 'left hepatic duct confluence extending to secondary radicals on the right' actually indicates Type IIIa. However, the question states left duct involvement with left PV occlusion — Type IIIb involves left secondary intrahepatic ducts. Left PV occlusion further indicates left lobe atrophy/hypertrophy phenomenon, typically seen with hilar cholangiocarcinoma, where the involved side shows atrophy due to portal vein occlusion.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.