INTRODUCTION: Blunt traumatic injuries to the extrahepatic biliary system are rare. Debate continues regarding the best way to diagnose and treat extrahepatic hepatic ductal injury (EHDI). The purpose of this study is to review and characterize the EHDI, and to evaluate the impact of endoscopic retrograde cholangiopancreatography (ERCP) on the treatment of EHDI. METHODS: A literature review was performed. A case from our institution was also added (total, 52 cases). Cases were then analysed (patient demographics, mechanism of injury, associated injuries, treatment modalities). RESULTS: Of 52 EHDI cases, 83% were men and 17% were women. Mean patient age was 22 years old (y/o) (men 23 y/o, women 16.2 y/o). Twenty patients were <18 y/o (38.5% cases, 13 male, 7 female). Fifty percent of injuries were automobile related - 36% motor vehicle crashes (MVC) and 14% automobile vs pedestrians. The remaining 50% of EHDI were due to crush injuries, motorcycle crashes, sports/recreational injuries, and falls. Mortality was 2/52 (3.8%). Isolated left hepatic duct (LHD) injury occurred in 24/52 (46.1%) cases. The right hepatic duct (RHD) was injured in 8 (15.4%) cases. Both LHD and RHD were injured in 7 (13.5%) cases. Bifurcation of hepatic ducts was involved in 13 (25.0%) cases. Delay from time of injury to correct diagnosis was common (mean 14 days, median 10 days). Fifteen injuries (33%) were missed at initial laparotomy or investigation. Reported mean length of hospital stay was 42 days. Associated injuries included liver (29/52 cases), lower extremity fractures (10), pelvic fracture(s) (9). Splenic injury and gallbladder injury were each reported in 5 cases. Concomminant non-EHDI biliary ductal injury was reported in 3 cases. Formal surgical exploration was carried out in 47 (90.4%) patients; 34 patients (65.4%) had definitive surgical repair by either biliary-enteric anastomosis or primary ductal repair. Recently, ERCP was utilized either diagnostically or therapeutically (17 of 52, 32.7%). Other treatment options included simple drainage, ductal ligation and stenting. Reported mean follow-up was 25.6 months. Follow-up ERCP results were reported in 7/17 patients. Six of 7 showed resolution of biliary leak and no evidence of biliary stricture and 1/7 showed non-visualization of the previously injured LHD. CONCLUSION: The management of EHDI continues to evolve. The availability of ERCP presents physicians with a new diagnostic and therapeutic option. Although definitive surgical treatment remains the gold standard, ERCP may assume increasingly important role in management of EHDI as its long-term results and safety record become better established.