In a patient who underwent laparoscopic cholecystectomy, bile leakage is noted postoperatively. ERCP shows a Strasberg E2 bile duct injury. Which structure has been transected?

• A Cystic duct only
• B Right hepatic duct only
• C Aberrant right posterior sectoral duct
• D Common hepatic duct 2 cm below the confluence ✓

Explanation

The Strasberg classification of bile duct injuries: Type A—cystic duct leak; Type B—occluded aberrant right hepatic duct; Type C—transected non-occluded aberrant duct; Type D—lateral injury to main bile duct; Type E (subdivided E1-E5 mirroring Bismuth classification)—transection/stricture of main bile duct. E2 = transection of the common hepatic duct greater than 2 cm below the confluence (Bismuth II). E1 is < 2 cm below the confluence. E3 involves the confluence, E4 involves both right and left hepatic ducts, and E5 involves a right sectoral duct plus main duct. This is the most important current classification for intraoperative and postoperative bile duct injuries.

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.