Bile duct injury (BDI) is associated with high morbidity and even mortality and represents an important clinical problem. The spectrum of BDIs ranges from small bile leaks to the complete transection of bile ducts and injuries with substance defects and concomitant vascular injuries requiring complex biliary reconstruction. BDIs should be diagnosed expediently, with adequate mapping of the injury, control of sepsis, and, when needed, referral to a tertiary care center for definitive treatment. This chapter discusses the diagnosis and management of these injuries.