Fig. 18

Two patients with biliary obstruction from iatrogenic early post-laparoscopic cholecystectomy biliary injuries. a–d On the 5th postoperative day, MRCP (a) showed usual postoperative collection at gallbladder fossa (*), dilated intrahepatic ducts and proximal CBD with abrupt termination (arrow) and normal choledochus distally to the discontinuity. Additional focused contrast-enhanced CT image (b) better showed the metallic clips and the MIP image (c) depicted the dilated intrahepatic bile ducts. The dilated common hepatic duct measured 14 mm in length, consistent with a Bismuth type II injury. After ERCP (d) confirmation of impassable obstruction, reoperation was required to remove the misplaced clips. (Adapted with permission from ref. [44].) e, f On the 12th postoperative day, CT (e) showed ascites, fluid collection in the surgical bed (*) and a CBD stricture (arrow) attributed to probable thermal injury, which was treated endoscopically with the positioning of a stent (thick arrow in post-procedural CT, f)