Image of the Month—Quiz Case | Gastrointestinal Surgery | JAMA Surgery | JAMA Network
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Special Feature
Aug 2011

Image of the Month—Quiz Case

Author Affiliations

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

Arch Surg. 2011;146(8):989. doi:10.1001/archsurg.2011.182-a

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.

A.  Concurrent common and left hepatic duct injuries

B.  Concurrent common and right hepatic duct injuries