Following a difficult laparoscopic cholecystectomy, a patient develops bilious drain output. ERCP shows complete transection of the common hepatic duct with contrast flowing freely around the catheter and no filling of the intrahepatic ducts. According to the Strasberg classification of bile duct injuries, this is:

• A Type C injury
• B Type D injury
• C Type B injury
• D Type E injury ✓

Explanation

Strasberg type E describes circumferential injury of the major bile ducts, subdivided into E1 to E5 using the Bismuth level system, and requires reconstruction, typically Roux-en-Y hepaticojejunostomy. Type B is occlusion of a sectoral duct without leak, type D is leakage from a transected sectoral duct with the main duct intact, and type C is a lateral injury to a major bile duct with the duct wall still partly continuous. Complete transection of a major duct is therefore type E.

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.