Using MR cholangiopancreatography to evaluate iatrogenic bile duct injury.

OBJECTIVE: The purpose of this study was to assess the role of MR cholangiopancreatography (MRCP) in the evaluation of iatrogenic bile duct injuries. SUBJECTS AND METHODS: In this prospective study, MRCP was performed in 10 postoperative patients (nine female and one male, ranging in age from 17 to 79 years) suspected of having bile duct injury as a result of surgery. Presence or absence of biliary dilatation, excision injury, stricture, fluid collection, and free fluid was noted. Excision injury was diagnosed if a segment of bile duct was not visible on any of the MRCP sequences. Positive cases were classified according to anatomic location and extent of injury. Results were compared with endoscopic retrograde cholangiopancreatography in five patients, percutaneous transhepatic cholangiography in one, surgery in four, and clinical follow-up in three. RESULTS: Three patients had normal findings on MRCP and remained asymptomatic on clinical follow-up. Four patients had bile duct excision injury on MRCP that was surgically proven, and one had stricture, confirmed by percutaneous transhepatic cholangiography. Of these five patients, one had Bismuth type I injury, two had type II, one had type III, and one had type IV. Two patients had findings suggestive of cystic duct leak on MRCP that were confirmed on cholangiography. CONCLUSION: MRCP can accurately diagnose postoperative biliary strictures and excision injuries and can characterize and anatomically classify these injuries for planning reparative surgery. It can also suggest the presence of cystic duct leaks in patients who have undergone cholecystectomy.