Bile duct injuries – Mnemonic

Strasberg and Bismuth classification

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

BBLOCK in part of biliary tree

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

DDEFECT (<50%) in common hepatic duct

EENTIRE 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 typeManagement
– Without retained stoneERCP + Sphincterotomy + Stent
– With retained stoneERCP + Sphincterotomy + Removal of stone + Stent
B and CHepatico-jejunostomy
– Small injuryPrimary repair around stent
– Extensive injuryHepatico-jejunostomy

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