SAGES Web Quiz #6 -- October 1998

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Question 1: This intraoperative cholangiogram points out which potentially catastrophic problem?

[] (a) a low insertion of the cystic duct
[] (b) a CBD laceration
[] (c) inadequate force of injection for cholangiogram
[] (d) a widely patent ampulla of Vater
[] (e) microcrystaline bile and sludge preventing proximal flow of contrast
[] (f) Don't Know

Question 2: The surgeon finds no CBD stones in the above cholangiogram, so completes the cholecystectomy. Which CBD injury pattern will likely result?(You may select more than one answer)

[] (a) a Bismuth type I injury.
[] (b) a Bismuth type II injury.
[] (c) a Bismuth type III injury.
[] (d) a Bismuth type IV injury.
[] (e) a Bismuth type V injury.

Question 3: On post-operative day 3, the patient from the earlier example complains of increasing pain, distention, fever and tachycardia. His liver enzymes are elevated. This ERCP reveals:

[] (a) complete obstruction of the common hepatic ducts
[] (b) clip obstruction of the cystic duct and fibrosis of the CBD.
[] (c) multiple "chain of lakes" demonstrative of chronic pancreatitis.
[] (d) complete obstruction of the common bile duct.
[] (e) incomplete filling of the hepatic ducts of unclear etiology.
[] (f) Don't Know

Question 4: This patient needs:(You may choose more than one answer)

[] (a) immediate hepatico-jejunostomy.
[] (b) control of any bile leakage and further evaluations.
[] (c) removal of the clips and end-to-end reconstruction of the CBD.
[] (d) referral to a specialty center for further evaluation and treatments.
[] (e) urgent laparoscopy and repeated cholangiography.

Question 5: Co-existing injuries that are common in the face of a CBD transection are:

[] (a) occlusion of the right hepatic artery.
[] (b) complete excision of the common hepatic duct.
[] (c) a "missing segment" of the main bile ducts.
[] (d) a bile leak from proximal duct(s).
[] (e) all of the above.
[] (f) Don't Know

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