The effectiveness of MRI cholangiography in diagnosing iatrogenic injuries of extrahepatic bile ducts

Objective. To retrospectively evaluate the effectiveness of magnetic resonance cholangiography (MRC) in diagnosing «minor» (type A) and «major» (types B-E) iatrogenic injuries of the extrahepatic bile ducts (EHBD) following cholecystectomy. Materials and methods. Over a 10-year period, at the Perm Regional Clinical Hospital, MRC was performed in 52 patients who developed complications in the early postoperative period after cholecystectomy for calculous cholecystitis. The type of EHBD injury was classified according to the Bismuth-Strasberg classification. When «minor» type A injuries were detected, patients underwent endoscopic treatment, including endoscopic retrograde cholangiopancreatography (ERCP), papillotomy and EHBD stenting; relaparoscopy was performed, if necessary, For the diagnosis of "major" injuries, open surgery with Roux-en-Y hepaticojejunostomy was performed. The. MRC results were compared with the ERCP or surgical findings. Results. MRC was performed in all patients 1-27 days after surgery. It enabled the diagnosis of cystic duct stump leakage (CDSL) in 27 cases and complete transection of the common bile duct (CBD) (20) or its clipping (5) at various levels in 25 cases. The main sign of CDSL on MRI cholangiograms was the presence of fluid near the cystic duct stump. In eleven patients with CDSL, biliary hypertension was detected due to stenosis of the major duodenal papilla, with (5) or without (6) choledocholithiasis. The accuracy of MRC in diagnosing CDSL was 96.29 %. In 20 patients, a complete transection of the EHBD at various levels was detected, in some cases (6), there was a significant bile duct tissue defect between its proximal and distal sections. Clipping of the EHBD was suspected in five cases based on the dilation of the bile duct and a blind termination of its distal part without fluid accumulation in the abdominal cavity. The level of intersection or clipping corresponded to E1 in 3 cases (12 %), E2 in 9 cases (36 %), E3 in 8 cases (32 %), E4 in 3 cases (12 %), and E5 in 2 cases (8 %). The accuracy of MRC in diagnosing "major" EHBD injuries was 100 %. Conclusions. MRC performed in the early postoperative period enables the diagnosis of all types of EHBD injuries with an accuracy of 96–100 %.