Hepatic duct confluence injury in blunt abdominal trauma - a diagnostic dilemma

Garge, Saurabh; Narasimhan, Kannan Lakshmi; Verma, Swapna; Sekhon, Virender

doi:10.5505/tjtes.2013.67026

Cited by 3 publications

(4 citation statements)

References 17 publications

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“…In simple transection, end-to-end anastomosis may be performed but if there is a loss of tissues, then hepaticojejunostomy must be performed. [4,5,6,11] In this case, the patient had cranial and kidney trauma and these ones were the obvious injuries which caused that biliary trauma has been missed. Free fluid in the abdomen could have been sampled before deciding not to do anything.…”

Section: Discussionmentioning

confidence: 89%

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

Köstek¹

2020

Ulus Travma Acil Cerrahi Derg

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Extrahepatic bile duct injuries are very uncommon and easily be missed in multitrauma patients. Patients suffer from bile duct injuries need special approach to this situation. In this report, a case with total transection of common hepatic duct and treatment approach was presented. In unstable patients, damage control surgery can be applied. A 32-year-old male patient was brought to the emergency department after a beating that includes multiple blunt trauma. Radiological screening showed cranial, nasal, lumbar vertebral, and costal bone fractures, decreased blood flow to the right kidney and free perihepatic and perisplenic fluid. Neurosurgeons operated this patient at the day of admission and no plan for laparotomy was made for this patient at that time. Second day postoperatively patient was transferred to the department of surgery and exploratory laparotomy has been made. Common hepatic duct was fully transected and because of the patient's hemodynamic instability, an external fistula has been made. The patient discharged 10 th day postoperatively. The patient was operated after follow-up and a Roux-en-y hepaticojejunostomy has been made. Extrahepatic bile duct injuries are rare and high suspicion is important in complex multitrauma patients. Extent of the injury is unique for every patient and technical aspect of repair can be challenging.

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Section: Discussionmentioning

confidence: 89%

“…In simple transection, end-to-end anastomosis may be performed but if there is a loss of tissues, then hepaticojejunostomy must be performed. [ 4 , 5 , 6 , 11 ]…”

Section: Discussionmentioning

confidence: 99%

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

Köstek¹

2020

Ulus Travma Acil Cerrahi Derg

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“…Injuries of this nature are complex and, due to their infrequency, often evade detection by trauma physicians. Incidence of extrahepatic biliary duct injury in the setting of blunt force trauma has been reported to be as low as 1 in 10,500 consecutive trauma cases [6] , with the first case being reported in 1799 [5] . Proper diagnosis requires a high index of suspicion and without an agreed upon universal protocol for management outcomes are widely variable [7] , [8] , [9] .…”

Section: Discussionmentioning

confidence: 99%

“…Seldom occurring in isolation, this family of injuries is easily overshadowed by more overt surgical emergencies and can go undetected, potentially leading to adverse outcomes. A variety of imaging modalities have been used to varying degrees of success in identifying biliary tree disruption for stable patients but in emergent settings exploratory laparotomy remains the most efficacious means for identifying injury [4] , [5] . This case presents an example of one such rare blunt force trauma shearing injury to the common bile duct in the setting of a motor vehicle collision.…”

Section: Introductionmentioning

confidence: 99%

Blunt trauma: An uncommon cause of common bile duct injury

Sanford

Abdolmaali

Robinson

et al. 2015

Trauma Case Reports

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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.

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Successful Endoscopic Treatment of Hepatic Duct Confluence Injury after Blunt Abdominal Trauma: Case Report

Park

Lee

et al. 2016

Journal of Trauma and Injury

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Hepatic duct confluence injury, which is developed by blunt abdominal trauma, is rare. Conventionally, bile duct injury was treated by surgical intervention. In recent decades, however, there had been an increase in radiologic or endoscopic intervention to treat bile duct injury. In a hemodynamically stable patient, endoscopic intervention is considered as the first-line treatment for bile duct injury.A 40 year-old man was transferred to the emergency department of OO trauma center after multiple blunt injuries. Contrast-enhanced abdominal computed tomography performed in another hospital showed a liver laceration with active arterial bleeding, fracture of the sacrum and left inferior pubic ramus, and intraperitoneal bladder rupture. The patient presented with hemorrhagic shock because of intra-peritoneal hemorrhage. After resuscitation, angiographic intervention was performed. After angiographic embolization of the liver laceration, emergency laparotomy was performed to repair the bladder injury. However, there was no evidence of bile duct injury on initial laparotomy. On posttrauma day (PTD) 4, the color of intra-abdominal drainage of the patient changed to a greenish hue; bile leakage was revealed on magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP). Bile leakage was detected near the hepatic duct confluence; therefore, a biliary stent was placed into the left hepatic duct. On PTD 37, contrast leakage was still detected but both hepatic ducts were delineated on the second ERCP. Stents were placed into the right and left hepatic ducts. On PTD 71, a third ERCP revealed no contrast leakage; therefore, all stents were removed after 2 weeks (PTD 85).ERCP and biliary stenting could be effective treatment options for hemodynamically stable patients after blunt trauma. [

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Hepatic duct confluence injury in blunt abdominal trauma - a diagnostic dilemma

Abstract: Isolated hepatic duct confluence injury due to trauma is unusual. Two cases of isolated bile duct injury are presented, which were diagnosed and managed successfully at our institution.

Cited by 3 publications

References 17 publications

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

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

Blunt trauma: An uncommon cause of common bile duct injury

Successful Endoscopic Treatment of Hepatic Duct Confluence Injury after Blunt Abdominal Trauma: Case Report

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