Bismuth classification

Clinical manifestation

Methods

cases

Type I

Low CBD stricture, with a length of the common hepatic duct stump of >2 cm.

Abdominal pain, fever, jaundice

Ultrasound or CT

9

Type II

Proximal CBD stricture-hepatic duct stump < 2 cm

Abdominal pain, fever, jaundice

Ultrasound or CT

12

Type III

Hilar stricture, no residual CBD, but the hepatic ductal confluence is preserved.

Bileleakageor bile peritonitis

ERCP or PTC

4

Type IV

Hilar stricture, with involvement of confluence and loss of communication between right and left hepatic duct.

Bile leakage or bile peritonitis

ERCP or PTC

3

Type V

Involvement of aberrant right sectoral hepatic duct alone or with concomitant stricture of the CBD.

Reccurent cholangitisor bile peritonitis

ERCP

3