Most patients with postoperative bile duct strictures after cholecystectomy present early after their initial operation. Patients may present in which of the following manner(s)?

a.Obstructive jaundice

b.An external biliary fistula

c.Progressive accumulation of bile in the peritoneal cavity (bile ascites)

Most patients with benign postoperative bile duct strictures present early after their initial operation. Those patients suspected of having postoperative bile duct stricture within days to one week of an initial operation usually present in one of two ways. One mode of presentation is the progressive elevation of liver function tests, particularly serum bilirubin and alkaline phosphatase. These changes can be seen as early as the second or third postoperative day. The second mode of early presentation is with leakage of bile from the injured bile duct. Bilious drainage from the operatively-placed drains or through the wound after cholecystectomy is abnormal and represents some form of biliary injury. In those patients without drains, or in whom the drains have been removed, the bile may leak into the peritoneal cavity as bile ascites or may loculate as a collection. Patients with markedly delayed diagnosis of bile duct stricture may present with advanced biliary cirrhosis and other evidence of liver dysfunction.