Non-surgical trauma to the extrahepatic biliary tract

Abstract

Non-surgical trauma to the extrahepatic biliary tract is uncommon and encountered only rarely by surgeons outside specialist hepatobiliary centres. Such injury often results in significant morbidity and mortality. This review outlines the incidence, classification, mechanisms of injury, presentation, diagnostic techniques and management options. Depending on the type of biliary injury identified, an optimal method of repair is suggested. Recommendations are made for surgeons who encounter this type of injury and do not have the appropriate expertise for definitive management.

Isolated Common Hepatic Duct Injury after Blunt Abdominal Trauma

“…The incidence of extrahepatic bile duct injury is known to be 1-5%. Extrahepatic bile duct injury is commonly associated with hepatic, duodenal, or pancreatic injuries, and isolated extrahepatic bile duct injury is rare [2]. Based on the severity and extent of the injury, multiple treatment modalities such as simple drainage, primary repair of the injured tissue, and/or enteric anastomosis, are used for the management of this condition [3].…”

Endoscopic Management of Perforation of Right Hepatic Duct Following Non‐Surgical Abdominal Trauma

“…Biliary tract injuries occur in 1-5% of cases following abdominal trauma [1][2][3][4]. Over 80% of such injuries are caused by penetrating trauma [2,[4][5][6].…”

“…Over 80% of such injuries are caused by penetrating trauma [2,[4][5][6]. Blunt abdominal trauma accounts for a minority of cases.…”

“…Such delayed presentation is known and occurs in 53% of cases [9]. Early presentation (shock and acute abdomen) and late presentation (obstructive jaundice) acccount for the remainder of cases [4]. Delay ranging from a few hours to 60 days, has been reported between clinical presentation and surgical intervention for isolated bile duct injury [7].…”

“…Delayed presentations includes symptoms like jaundice, abdominal distention, abdominal pain and fever, due to extravasation of bile in the peritoneal cavity, which were all seen in our patient. [4,10] …”