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 common bile duct. These injuries appear normal on ERCP (Endoscopic Retrograde Cholangiopancreatography) because the main biliary tree remains intact and patent. The contrast injected during ERCP will fill the biliary system normally without showing obstruction or discontinuity of the major ducts. Type A injuries typically involve peripheral ducts or the cystic duct stump that leak bile but maintain connection to the main biliary system. The other types (B through E) involve various degrees of major duct injury or transection that would be visible as abnormalities on ERCP, such as complete obstruction, strictures, or disconnected segments of the biliary tree.
Key Points
- Type A injuries are characterized by bile leaks from minor ducts still in continuity with the common bile duct 1.
- ERCP is effective in diagnosing postoperative biliary tract lesions, and can help decide the best therapeutic approach 2.
- The Strasberg Bismuth classification is used to classify biliary ductal injuries, with Type A being the least severe 3.
- ERCP is a helpful procedure for diagnosing biliary and pancreatic duct injury in a select group of trauma patients who do not have obvious indications for exploration 4.
Management
- Endoscopic therapy is safe and effective in the management of postoperative bile duct leak 1.
- ERCP with stenting and sphincterotomy is a useful treatment for biliary fistulae after severe liver trauma 5.
- A multidisciplinary approach is necessary for the management of biliary ductal injuries, including surgery, interventional gastroenterology, and interventional radiology 3.