From the Research
The answer is Type A. In the Strasberg Bismuth classification for biliary ductal injury, Type A injuries represent bile leaks from minor ducts still in continuity with the main biliary system, typically from the cystic duct stump or small ducts in the liver bed. These injuries will appear normal on ERCP (Endoscopic Retrograde Cholangiopancreatography) because the main biliary tree remains intact and undamaged. The contrast injected during ERCP will fill the normal biliary tree without demonstrating any obstruction or discontinuity. The bile leak occurs from peripheral ducts that may not be visualized during the procedure. Types B through E all involve varying degrees of damage to the main biliary ducts, including transection, strictures, or occlusion, which would be evident on ERCP as abnormalities in the biliary tree appearance. According to the study by 1, the most frequent types of IBDI were D (17/46,36.9%) and A (15/46,32.6%), which suggests that Type A injuries are common and may not be visible on ERCP. Additionally, the study by 2 found that cholangiogram was normal in 29 patients (11.2%), which further supports the idea that Type A injuries may appear normal on ERCP. It's worth noting that the study by 3 is not directly related to the question, as it discusses the endoscopic management of recurrent acute pancreatitis, rather than biliary ductal injuries. Therefore, based on the available evidence, Type A injuries will appear normal on ERCP. Some key points to consider when evaluating biliary ductal injuries include:
- The Strasberg Bismuth classification system, which categorizes injuries based on their location and severity
- The use of ERCP to diagnose and treat biliary ductal injuries
- The importance of considering the patient's overall clinical presentation and medical history when evaluating biliary ductal injuries.