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Image of the Month—Quiz Case FREE

Chad G. Ball, MD, MSc, FRCSC; Michael G. House, MD; Keith D. Lillemoe, MD
[+] Author Affiliations

Author Affiliations: Department of Surgery, Indiana University, Indianapolis.


Arch Surg. 2011;146(8):989. doi:10.1001/archsurg.2011.182-a.
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A 27-year-old woman was referred to our center with a 13-month history of persistent abdominal pain in the right upper quadrant without jaundice following a laparoscopic cholecystectomy for cholelithiasis. Endoscopic retrograde cholangiopancreatography failed to opacify her left hepatic ducts and demonstrated a paucity of right intrahepatic ducts. Concurrent cross-sectional imaging noted dilated left intrahepatic ducts and significant left hemiliver atrophy. Both percutaneous transhepatic cholangiography (Figure 1) and magnetic resonance cholangiography (Figure 2) revealed complete occlusion of the common hepatic duct at the site of metal clips.

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Figure 1. Percutaneous transhepatic cholangiography with occlusion of the common hepatic duct at the site of metal clips.

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Figure 2. Preoperative magnetic resonance cholangiography of the injury. CBD indicates common bile duct; LHD, left hepatic duct; RAHD, right anterior hepatic duct; RPHD, right posterior hepatic duct.

WHAT IS THE DIAGNOSIS?

A.  Concurrent common and left hepatic duct injuries

B.  Concurrent common and right hepatic duct injuries

C.  Isolated common hepatic duct injury with anomalous  right hepatic duct anatomy

D.  Isolated left hepatic duct injury

Figures

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Graphic Jump Location

Figure 1. Percutaneous transhepatic cholangiography with occlusion of the common hepatic duct at the site of metal clips.

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Figure 2. Preoperative magnetic resonance cholangiography of the injury. CBD indicates common bile duct; LHD, left hepatic duct; RAHD, right anterior hepatic duct; RPHD, right posterior hepatic duct.

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