Blunt trauma: An uncommon cause of common bile duct injury

Abstract

Blunt force trauma to the extrahepatic biliary ductal system as a cause of avulsion is an uncommon injury associated with wide variability in prognosis. These cases are often difficult to identify, primarily as they are complicated by trauma patients exhibiting more immediate and obviously life-threatening injuries. This case demonstrates a 46 year-old-male involved in a head on motor vehicle collision, sustaining blunt force abdominal trauma resulting in partial transection of the common bile duct. Injury was discovered incidentally on exploratory laparotomy post endovascular repair of abdominal thoracic aortic rupture. Open cholescystectomy with intraoperative cholangiogram was performed, isolating extravasation from the common bile duct. A 16-French T-tube was placed in the common bile duct and two large #24 Jackson-Pratt tubes were placed in the vicinity. The procedure was well-tolerated and the patient was discharged with T-tube in place. Discharge was on postoperative day 28 with removal of tubes on postoperative day 54 and the patient was able to make a full recovery.

Post-traumatic Isolated Right Hepatic Duct Injury: A Case Report

“…The most common anatomic locations of traumatic biliary injuries are the origin of the left hepatic duct; the point of bifurcation of the left and right hepatic ducts and the pancreaticoduodenal junction. 4 Pereira et al 5 conducted a systematic review of a total of 66 cases of traumatic bile duct injuries. They reported that complete transection of the common bile duct (suprapancreatic and intrapancreatic) were the most common injuries reported followed by partial laceration of the left hepatic duct; partial laceration of the right hepatic duct; and complete laceration of the right hepatic duct.…”

Diagnostic imaging in a patient with an isolated blunt traumatic gallbladder injury

“…Isolated gallbladder injury due to blunt abdominal trauma is often difficult to diagnose preoperatively because of multiple factors such as being a very rare pathology and the variable and nonspecific clinical manifestations depending on the injury pattern [ 1 , 2 ]. Many cases are diagnosed early using modalities such as ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), peritoneal aspiration, endoscopic retrograde cholangiopancreatography (ERCP), scintigraphy, and explorative laparoscopy [ 3 – 5 ]. Searching relevant English literature, we selected 33 published articles with 34 cases of gallbladder injury with at least one of the above diagnostic methods performed.…”

Delayed Diagnosis and Successful Management of Completely Transected Common Hepatic Duct In A Blunt Multi-Trauma Patient

“…[ 1 , 2 ] Extrahepatic biliary injuries after blunt trauma can be easily missed, especially when they have seen with other injuries. [ 3 ] Late findings after admission such as jaundice, fever, slightly increased abdominal pain, tenderness, and radiological findings like increased fluid in the abdomen can increase the suspicion about extrahepatic biliary injuries. Injuries to the extrahepatic biliary ducts can be partial or total and this changes how to approach to the injury.…”