Management of blunt and penetrating biliary tract trauma

Thomson, Benjamin; Nardino, Benson; Gumm, Kellie; Robertson, Amanda; Knowles, Brett; Collier, Neil A.; Judson, Rodney

doi:10.1097/ta.0b013e318248ed65

Cited by 29 publications

(26 citation statements)

References 19 publications

(9 reference statements)

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“…The incidence of bile duct injury following a blunt trauma is less than 0.5% for patients undergoing laparotomy for blunt abdominal trauma, and this incidence is much lower when the lesion is located in the intrapancreatic common bile duct [1,2]. Unlike bile duct injuries after laparoscopic cholecystectomy, most lesions of the extrahepatic bile duct related to blunt trauma are distal to the confl uence (type I lesions as classifi ed by Bismuth) [3]. The incidence of extrahepatic biliary duct injury following a blunt trauma has been reported to be as low as 1 in 10.500 trauma cases [4], and complete common bile duct transection is particularly rare too [5].…”

Section: Discussionmentioning

confidence: 99%

Intrapancreatic Lesion of Biliary Duct Following a Blunt Trauma: A Rare Entity Difficult to Identify with Conservative Management

Jiménez-Fuertes¹,

Ruíz-Tóvar²,

Durán-Poveda³

et al. 2017

Open J Trauma

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Lesions of the biliary duct following a blunt abdominal trauma occurs infrequently, and even more so when it occurs in the intrapancreatic biliary duct. With the increase of conservative treatment in blunt abdominal trauma, the diagnosis of this entity can be diffi cult and delayed. We present the case of a lesion of the intrapancreatic biliary duct following a blunt trauma. A 51-year-old male patient was treated following a bicycle accident. Initial CT scan showed multiple bilateral rib fractures and grade 2 liver injury in segment VII. On the basis of these fi ndings and the stability of the patient, a conservative treatment was adopted. On the 9 th day following admission he developed a progressive jaundice. This prompted a Doppler ultrasonography of the liver, showing no abnormalities in the pedicle or hepatic vessels, as well as an MR-cholangiography, which only revealed an increased amount of abdominal fl uid without dilatation of the bile duct and without apparent injury of the duct. Upon the onset of fever and general worsening of the patient's condition, an exploratory laparotomy was performed on the 16 th day following admission, revealing plenty of intraperitoneal bile fl uid, but a visual examination of the bile duct failed to determine the site of injury. An intraoperative ERCP was performed, revealing a lesion of the intrapancreatic bile duct, after which a biliary stent was inserted. In the early postoperative period the patient developed a leak through the external biliary drains placed during laparotomy. A new ERCP was therefore performed, together with the insertion of a coated metal prosthesis, after which the patient progressed satisfactorily. Damage to the intrapancreatic bile duct by blunt abdominal trauma is a rare entity, diffi cult to diagnose, especially with the increase of conservative treatment of associated injury such as liver damage. MR cholangiography and ERCP play a fundamental role in the diagnosis and actual endoscopic treatment of these injuries (with or without a surgical cavity wash) and, when feasible, this constitutes the best option for treatment.

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Section: Discussionmentioning

confidence: 99%

Intrapancreatic Lesion of Biliary Duct Following a Blunt Trauma: A Rare Entity Difficult to Identify with Conservative Management

Jiménez-Fuertes¹,

Ruíz-Tóvar²,

Durán-Poveda³

et al. 2017

Open J Trauma

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“…Lesions in other intra-abdominal organs in association with biliary tract lesions are considered the rule by many, occurring in more than 97% of cases. 1,5 As a consequence, there are several ways to treat biliary tract lesions, and many are the variables that must be considered.…”

Section: Diagnosismentioning

confidence: 99%

“…There are few publications in the literature on treatment outcomes of biliary lesions resulting from blunt or penetrating trauma. Thomson et al 1 report that there are only eight publications in the English literature with more than 10 patients with extra-hepatic biliary lesions, excluding those natural and related to the gallbladder. A little more than 250 cases of blunt bile tract traumas have been documented in the literature until the end of the last century.…”

Section: Diagnosismentioning

confidence: 99%

“…It is estimated that many patients die on their way to the hospital due to biliary tract lesions and bleeding caused by often associated vascular lesions. 1,3,5 At the João XXIII Hospital, 70 biliary lesions (1.5%) occurred out of the 4,526 laparotomies performed between 1990 and 1998. These included 63 cases of bladder lesions and seven of extra-hepatic bile duct lesions.…”

Section: Incidence and Mortalitymentioning

confidence: 99%

“…The sphincterotomy with endoscopic placement of a stent in the main biliary ducts of fistulas with high debit (200 mL/day) is prudent. 1,9,10 Konstatakos et al 5 manifest a contrary opinion by stating that such procedure increases the incidence of iatrogenic lesions. b. treatment of gallbladder lesion: cholecystectomy is the gold standard for treatment of lesions in the gallbladder.…”

Section: Trauma Mechanism and Pathophysiologymentioning

confidence: 99%

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Approach to trauma biliary lesions at the João XXIII Hospital

Drumond¹,

Castro²,

Abrantes³

2014

Revista Médica De Minas Gerais

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Trauma biliary lesion is not common. It is observed, regardless of its mechanism, in 0.1% of admissions to trauma services. The gallbladder is the segment of the biliary extra-hepatic pathway most often affected. Lesions of bile ducts constitute a challenge to medical expertise, with significant morbidity; treatment is dependent on several factors such as degree of lesion, time of diagnosis, and medical staff experience in their approach. Due to the rarity of these lesions, surgical correction is difficult and controversial. This review presents the perspective on this topic from the Service of General Surgery and Trauma at the João XXIII Hospital and the Hospital Foundation of the State of Minas Gerais highlighting its incidence, mechanism of lesion, and treatment.

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