Extrahepatic Biliary Tree Injury Scale

Traumatic injury to the extrahepatic biliary tree can be graded using the Extrahepatic Biliary Tree Injury Scale.

Type of Injury	Involvement	Grade
contusion/hematoma	gallbladder contusion/hematoma	I
	portal triad contusion/hematoma	I
avulsion	partial gallbladder avulsion from liver bed, with cystic duct intact	II
	complete gallbladder avulsion from the liver bed	III
laceration	laceration or perforation of gallbladder	II
	cystic duct partial laceration	III
	right hepatic duct partial laceration	IV
	left hepatic duct partial laceration	IV
	common hepatic duct partial laceration (< 50%)	IV
	common bile duct partial laceration (< 50%)	IV
	combined right and left hepatic duct injuries	V
	intraduodenal bile duct injury	V
	intrapancreatic bile duct injury	V
transection	transection of cystic duct	III
	transection of right hepatic duct	IV
	transection of left hepatic duct	IV
	transection of common hepatic duct (> 50%)	V
	transection of common bile duct (> 50%)	V

where:

• "injury to" both right & left hepatic, intraduodenal, and intrapancreatic bile ducts is assumed to be a laceration

If multiple injuries are present, increase the grade by 1 up to Grade III.

where:

• I am assuming that a Grade II lesion can be upgraded to Grade III, but not Grade III to Grade IV (see Testis Injury Scale).

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