PMC9425897_01
Trans-hepatic PTC reveals a stricture at the distal left biliary duct with bile draining into a collection adjacent to the proximal duodenum and severe narrowing of the second part of the duodenum.
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Percutaneous cholangiography (PTC) demonstrated bile drainage into a collection with a CBD stricture and biliary drains out of place (Figure 1).
PMC9425897_02
Clip locations noted in Case 2: (a) Toward the bifurcation of the cystic duct with the common hepatic duct, (b) obliterating part of the hepatic duct, and (c) completely transecting the right hepatic artery.
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One clip was found toward the bifurcation of the cystic duct with the common hepatic duct and another below it was obliterating part of the common hepatic duct (Figure 2).
PMC9425897_03
Intraoperative cholangiogram through the cystic duct stump.
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We performed an exploratory laparotomy and an intraoperative cholangiogram (IOC) which showed an intact biliary tree with no evidence of bile leak (Figure 3).
Transected double cystic duct lumen identified during exploration of the porta hepatis (pointed at by the forceps).
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Exploration of the porta hepatis revealed a second CBD with a transected lumen that was draining bile (Figure 4).
IOC done through the transected lumen identified during exploration of the porta hepatis.
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A second cholangiogram was performed intraoperatively through that lumen and revealed an intact intrahepatic biliary duct (Figure 5).
PMC9425897_04
Complete pedicle injury with complete transection of the hepatic duct along with the portal vein and hepatic artery.
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Surgery was performed, and a complete pedicle injury was identified (Figure 6).