Three days after an uncomplicated laparoscopic cholecystectomy, a 50-year-old woman develops painless jaundice and bilious drain output. MRCP reveals a clip across the common hepatic duct just below its bifurcation with free flow of contrast proximally. The definitive management of choice is:

• A Roux-en-Y hepaticojejunostomy ✓
• B Primary end-to-end repair of the duct over a T tube
• C Endoscopic placement of a self-expanding metal stent across the occluded segment
• D Choledochoplasty with a gallbladder patch flap

Explanation

C completely occluded or transected major bile duct cannot be managed endoscopically because there is no continuity for stenting. Primary end-to-end repair has a high rate of late stricture and is discouraged. The standard definitive repair for iatrogenic major duct injury is a tension-free Roux-en-Y hepaticojejunostomy, ideally performed or supervised by an experienced hepatobiliary surgeon, with results best when done early before inflammation matures. Stenting works only for partial injuries with preserved ductal continuity.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.