Bile duct rupture is a complete break or partial defect of the damaged bile duct, or inflammation and fibrosis of the bile leak occurring only by vascular clamp compression or by suturing, and finally causing bile duct stenosis or occlusion. Bile duct rupture is commonly associated with scarring narrowing of the bile duct lumen due to bile duct injury, i.e., benign bile duct stricture. How is bile duct rupture diagnosed? (A) History and symptoms History of biliary tract or epigastric surgery (trauma), or history of recurrent biliary duct infections. (①Obstructive jaundice within 24 hours after surgery (injury), or a large amount of bile overflowing from the drainage port, or no symptoms in the early postoperative period (injury), but intermittent epigastric dull pain, chills and fever, jaundice, and gray stools several weeks to years later. ②Charcot’s triad may be present in acute attacks. (③In chronic cases, there is prolonged jaundice, irregular febrile pattern, jaundice deepening after fever, and biliary cirrhosis. Or there is cholangitis without jaundice. In severe cases, the disease progresses rapidly, deteriorates rapidly, and ACST and sepsis appear. (II) Signs ① Epigastric pressure pain during the attack. ②Jaundice. (iii) Hepatomegaly and pressure pain. X-ray imaging of benign biliary stenosis ④Signs of portal hypertension may be present, etc. (iii) Ancillary tests ① elevated white blood cell and neutrophil counts; laboratory tests showing obstructive jaundice; heavy liver function impairment with inverted white and globulin ratios; blood cultures may be positive. ② Retrograde cholangiography, PTC, ERCP, can show the site, morphology and extent of stenosis. The bile ducts are not visualized, and biliary strictures cannot be excluded. Sometimes intravenous cholangiography can also show the diseased bile duct. (iii) B-mode ultrasound can show the sonogram of dilated, or (and) stone in the proximal bile duct of the stricture. Intraluminal bile duct ultrasound (IDUS) is of special value for the diagnosis of the etiology of bile duct strictures. The sonographic features of different lesions of bile duct strictures can identify benign and malignant bile duct lesions. ④MRCP can correctly diagnose biliary stenosis after liver transplantation, but it tends to exaggerate the degree of stenosis due to the lower resolution compared to ERCP due to the lack of clear details of the lesion. Dynamic observation of alkaline phosphatase and γ-glutamylase, MRCP can make early diagnosis.