The proximal anastomosis should ideally be at the level of the right and left hepatic duct
confluence, without leaving a cuff of residual cyst.
The left hepatic duct
near the hilar plate was included in the pericystic wall near segment 3.
The height of the injury is usually referenced by using the Bismuth scale, which gauges an injury based on its location in relationship to the confluence of the right and left hepatic duct.
From the liver, the bile initially passes into the right and left hepatic ducts.
The biliary anastomosis is technically difficult because it is performed at the level of the right or left hepatic duct
Therefore, a percutaneous cholangiogram (PTC) was undertaken, which revealed a left hepatic duct
Abdominal ultrasound studies showed a lobulated cystic mass in the left lobe of the liver and a filling defect in the left hepatic duct, extending 4 cm along the common bile duct.
On gross examination, the left hepatectomy specimen included a globular, 15-cm, cystic tumor arising from the left hepatic duct.
It can be used for guiding and exchanging endoscopic accessories in the biliary system, including the common bile, cystic, pancreatic and right and left hepatic ducts
Magnetic resonance i maging (MRI) of the abdomen with cholangiographic reconstruction showed an isolated stricture in the common hepatic duct close to the junction of the right and left hepatic ducts