Intraductal Papillary Neoplasm of the Bile Duct (IPNB) is a rare biliary tumor with malignant potential. Recurrence may occur as extensive intraductal lesions after hepatectomy.

A 65-year-old woman with prior left hepatectomy presented one year later with recurrent cholangitis. Biological tests showed cholestasis. ERCP revealed an elongated intraductal defect in the right hepatic duct and mid-common bile duct. Cholangioscopy showed a continuous, macronodular papillary lesion with an obstructive nodule. Targeted biopsies confirmed high-grade dysplasia.

This case highlights cholangioscopy’s role in post-surgical biliary neoplasms, allowing accurate lesion mapping, differentiation from postoperative changes, and safe guidance of management.