Value of MR cholangiography in patients with iatrogenic bile duct injury after cholecystectomy.
OBJECTIVE
Our aim was to determine the diagnostic role of MR cholangiography in the evaluation of iatrogenic bile duct injuries after cholecystectomy.


METHODS
Nineteen patients (14 women and five men; mean age, 47 years; age range, 24-75 years) with suspected bile duct injury as a result of laparoscopic cholecystectomy (17 patients) and open cholecystectomy (two patients) underwent MR cholangiography. MR images were evaluated for bile duct discontinuity, presence or absence of biliary dilation, stricture, excision injury, free fluid, and collections. Bile duct excision and stricture were classified according to the Bismuth classification. Final diagnosis was made on the basis of findings at surgery in 15 patients, on percutaneous transhepatic cholangiography (PTC) in one patient, and on endoscopic retrograde cholangiography (ERC) and at clinical follow-up until hospital discharge in the remaining three patients.


RESULTS
In 16 patients, injury of the bile duct was observed. Two patients had Bismuth type I injury; one patient, type II injury; 11 patients, type III injury; and one patient each, type IV and V injuries. Three patients showed findings suggestive of leakage from the cystic duct remnant, which were confirmed on ERC.


CONCLUSIONS
MR cholangiography is an accurate diagnostic technique in the identification of postoperative bile duct injuries. This technique allows exploration above and below the level of obstruction, a resource provided by neither ERC nor PTC, and allows the accurate classification of these injuries, which is essential for treatment planning.
Ragozzino
Alfonso
A
Department of Radiology, Cardarelli Hospital, Via Pansini 5, Via Manzoni 214/0, Naples 80123, Italy.
De Ritis
Rosaria
R
Mosca
Alessandro
A
Iaccarino
Vittorio
V
Imbriaco
Massimo
M
D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000293:injuries*; D049448:Cholangiopancreatography, Magnetic Resonance; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies