From the Research
In the Strasberg-Bismuth classification for biliary ductal injury, Type A injuries will appear normal on Endoscopic Retrograde Cholangiopancreatography (ERCP). Type A injuries represent bile leaks from the cystic duct stump or small ducts in the liver bed without major bile duct injury. During ERCP, the main biliary tree appears intact and normal because the injury affects only minor peripheral ducts or the cystic duct remnant. The contrast injected during ERCP fills the biliary system normally without demonstrating strictures, transections, or occlusions of the main bile ducts. This is because Type A injuries don't involve structural damage to the main biliary tree that would be visible on cholangiography. The bile leak in Type A injuries typically manifests as extravasation of bile into the peritoneal cavity, causing biloma formation or bile peritonitis, but the biliary tree itself remains structurally intact when visualized during ERCP.
Some key points to consider:
- The Strasberg-Bismuth classification is a system used to categorize bile duct injuries, with Type A being the least severe and Type E being the most severe 1.
- Type A injuries are characterized by bile leaks from the cystic duct stump or small ducts in the liver bed, without major bile duct injury 2.
- ERCP is a diagnostic tool used to visualize the biliary tree and diagnose bile duct injuries 3.
- In Type A injuries, ERCP may appear normal because the main biliary tree is intact and the injury is limited to minor peripheral ducts or the cystic duct remnant 4.
- The management of bile duct injuries depends on the type and severity of the injury, with Type A injuries often being managed conservatively or with minimally invasive procedures 5.