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Mnemonics, Simplified Concepts & Thoughts

Bile duct injuries – Mnemonic

Epomedicine, Aug 28, 2023Aug 28, 2023

Last updated on August 28, 2023

Strasberg and Bismuth classification

A – bile leak from part ATTACHED to biliary tree (cystic duct or duct of Luschka)

B – BLOCK in part of biliary tree

C – bile leak from CUT-OFF duct (not in communication) with the biliary tree

D – DEFECT (<50%) in common hepatic duct

E – ENTIRE circumference (100%) injury to common hepatic duct (sub-classified using Bismuth classification from E1 to E4 with strictures moving proximally towards confluence; E5 is a separate entity)

  • E1 – >2 cm distal to hepatic duct confluence
  • E2 – <2 cm distal to hepatic duct confluence
  • E3 – hilar stricture with intact confluence
  • E4 – hilar stricture with involvement of confluence
  • E5 – strictures involving right aberrant sectoral duct and common hepatic duct
strasberg bismuth classification
(PDF) Is There a Role for Endoscopic Therapy as a Definitive Treatment for Post-Laparoscopic Bile Duct Injuries? (researchgate.net)

Management

Strasberg typeManagement
A
– Without retained stoneERCP + Sphincterotomy + Stent
– With retained stoneERCP + Sphincterotomy + Removal of stone + Stent
B and CHepatico-jejunostomy
D
– Small injuryPrimary repair around stent
– Extensive injuryHepatico-jejunostomy
EHepatico-jejunostomy
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PGMEE, MRCS, USMLE, MBBS, MD/MS Gastrointestinal systemGeneral Surgery

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Comments (2)

  1. Ajay Shanker verma says:
    Oct 15, 2023 at 11:14 am

    Awesome

    Reply
  2. Koch says:
    May 28, 2024 at 9:01 am

    Thank you!

    Reply

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Epomedicine. Bile duct injuries – Mnemonic [Internet]. Epomedicine; 2023 Aug 28 [cited 2025 May 9]. Available from: https://epomedicine.com/medical-students/bile-duct-injuries-mnemonic/.

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