Bile Duct Disruption after Blunt Hepatic Trauma: Treatment with Percutaneous Repair

Blunt Left Extrahepatic Bile Duct Injury: Case Report and Literature Review

“…As for blunt injury affecting the right or left hepatic ducts or the duct confluence, Sakamoto et al [3] stated finding only 30 reports in the English-language literature from 1929 to 1995. Including the two cases of Sakamoto et al we have found an additional nine reported adult cases after 1995 [1][2][3][4][5][6].…”

“…Published time delays between the date of admission and the diagnosis of biliary tract injury after blunt abdominal trauma vary greatly and can be days to months. For instance Eid et al [4] reported diagnosis of a partial left hepatic duct tear on hospital day 9 and Miyayama et al [6] confirmed a bile duct disruption in the days following discovery of a biloma 46 days after initial presentation.…”

“…Two types of conditions contribute to delayed diagnosis: (1) delay secondary to diagnostic difficulty and (2) delay from delayed onset of biliary tract disruption [6]. Reasons for difficulty diagnosing a leak include: (1) insidious onset and poor specificity of clinical symptoms, (2) the attribution of biloma to parenchymal injury rather than extrahepatic duct injury, (3) the attribution of jaundice to massive transfusion or hematoma resolution rather than extrahepatic duct injury [5], (4) the low incidence of blunt traumatic biliary tract injury.…”

Common bile duct stricture due to blunt abdominal trauma: report of two cases

“…Furthermore, there are many individual differences in this blood flow control, and it is believed that ischemia occurs in some cases, while it does not occur in other cases, even with similar trauma. There are many reports in which ischemia of the bile duct causes bile duct stenosis such as a report in which a biloma was formed after embolic therapy had been performed in a case of intra-abdominal hemorrhage due to hepatic trauma 16) , a report in which biloma formation and biliary tract obstruction occurred after hepatic artery embolization (using lipiodol) in a case of hepatic cancer 17) , a report explaining that biliary tract complications, including bile duct stenosis, are frequently seen if hepatic artery occlusion occurs in cases of liver transplantation 18) , and a report in which artery obstruction was observed in the angiography in 39 to 47% of cases of bile duct stenosis after a cholecystectomy 7) . Furthermore, periductal fibrosis and denuded epitherium cells are regarded as pathological findings in cases in which bile duct stenosis develops after hepatic artery embolization 17) , and similarly to pathological findings after blunt abdominal trauma, fibrosis is regarded as the cause of stenosis.…”

Traumatic Bile Duct Injuries

“…In patients affected by blunt trauma, the portal vein and hepatic artery are not usually injured because these structures are longer and more elastic than the main bile duct. Also, when patients suffer damage to vascular structures of the hepatoduodenal ligament, most of the times they do not survive the accident and are pronounced dead before arrival to the emergency department [1,[13][14][15][16][17][18][19][20][21][22][23][24].…”