Iatrogenic injury to the bile duct: a working classification for radiologists.

PURPOSE

To assess the usefulness of the Bismuth classification method in the preoperative localization of iatrogenic bile duct lesions with cholangiography and to correlate these cholangiographic findings with surgical findings.

MATERIALS AND METHODS

The records of 33 patients who underwent open or laparoscopic cholecystectomy and who sustained injuries to the biliary tract during the course of these procedures were reviewed retrospectively. The accuracy of the cholangiographic localization of bile duct injury was assessed with the Bismuth classification method, which is based on the localization of the traumatic lesion according to the distance from the biliary confluence.

RESULTS

An exact correspondence between cholangiographic and surgical findings was found in 85% of the subjects. A minimal discrepancy was found in the remainder. There was no interobserver variation.

CONCLUSION

The use of the Bismuth classification method appears to be an accurate and practical method for the grading of postoperative bile duct lesions with cholangiography.