Post-cholecystectomy iatrogenic bile duct injuries: Emerging role for endoscopic management

Figure 4 Suggested algorithm for optimal timing of Endoscopic Retrograde Cholangio-Pancreatography in the management of bile duct injuries. Cases with suspected bile duct injuries should be thoroughly evaluated with meticulous history taking, clinical examination with special attention for the surgical drains. Abdominal ultrasonography usually is the first non-invasive diagnostic modality together with laboratory investigations. Those patients are preferably examined by MRCP before the decision to proceed for Endoscopic Retrograde Cholangio-Pancreatography (ERCP). ERCP should no be more done as a diagnostic technique. Patients should go to ERCP only if any degree of bile cut continuity is detected during the Magnetic Resonance Cholangio-Pancreatography examination. BDI: Bile duct injuries; MRCP: Magnetic Resonance Cholangio-Pancreatography; ERCP: Endoscopic Retrograde Cholangio-Pancreatography; US: Ultrasonography; GB: Gallbladder; CBD: Common bile duct.