Following laparoscopic cholecystectomy, a patient develops a major bile leak. ERCP shows complete transection of the common hepatic duct with contrast flowing freely into the peritoneal cavity and no opacification of the intrahepatic ducts. In the Strasberg classification this injury is:

• A Type A
• B Type E1 ✓
• C Type D
• D Type C

Explanation

Strasberg types A to D describe leaks and partial injuries, while type E injuries are major biliary confluence injuries subdivided E1 to E5 using the Bismuth levels. Complete transection of the common hepatic duct more than 2 cm below the confluence with intact ductal continuity above is E1. Type A is a leak from the cystic stump, type B is transection without leak of a duct, and type D is a lateral injury to a major duct.

Reference: Blumgart's Surgery of the Liver, Biliary Tract and Pancreas, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.