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OBJECTIVES Detection of different bile duct injuries by laparoscopic intraoperative ultrasonography was evaluated in a blind randomized animal study. SUMMARY BACKGROUND DATA Only the third or less of bile duct injuries that occur during laparoscopic cholecystectomy are detected at the primary operation in spite of using intraoperative cholangiography. There is a need for investigative other intraoperative diagnostic methods for their possibility of detecting bile duct injuries like laparoscopic ultrasound. METHODS Fifty bile duct injuries were created using laparoscopic techniques in 23 fariner pigs. The number of the single lesions and the other in which the injuries were created was randomly assigned. The lessions created were: #1. Partial occlusion by a clip, #2. Complete occlusion by a clip, #3. Partial laceration, #4. Transection without clips, #5. transection between clips, #6. Excision between clips. There were also cases without lessions. Different type of clips were used. By laparoscopic ultrasound using a flexible probe, a screening of the injuries was attempted. The study was performed in a blin fashion. RESULTS<7b> Complete imaging of the hepatic and common bile duct from its bifurcation to the insertion in the duodenum was accomplished in all 23 animals before surgery was done. All 8 cases where no lesion was performed were recognized correctly. In 48 of 49 cases the injuries was realized (sensitivity: 98%). One injury was obvious without ultrasound. There were 44 exact diagnoses and 12 cases where injuries were recognized but could not differentiated exactly (specificity of 100%, overall accuracy of 98.3%). There was only one false diagnosis. The different type of clips could also be differentiated. CONCLUSIONS Laparoscopic ultrasonography can reliably visualize most relevant bile duct injuries. A standard for doing the ultrasound examination is proposed. Direct and indirect ultrasound signs of bile duct injuries are explained.