Question

According to the Bismuth / Strasberg classification, 'cystic duct blow out' (cystic duct stump leak) is classified as:

• A. Type A
• B. Type B
• C. Type C
• D. Type D

Hint:

A leak from a minor duct still in continuity is the lowest grade.

Answer 1

The Correct Option is A

Step 1: The Strasberg (Bismuth-Strasberg) classification grades bile duct injuries after cholecystectomy from A to E.
Step 2: Type A is a bile leak from a minor duct still in continuity with the main duct, classically the cystic duct stump leak or a leak from a small duct in the gallbladder bed (duct of Luschka). A cystic duct stump blow out is the prototype Type A injury.
Step 3: Type B is occlusion of an aberrant right hepatic duct, and Type C is a transected aberrant right hepatic duct that leaks. Type D is a lateral injury to the main bile duct. Type E covers circumferential injuries of the main duct (further subdivided E1 to E5).
Step 4: Since the cystic duct stump is a minor duct in continuity, its leak fits Type A, not B, C or D.
Conclusion: The correct answer is A. Type A.