Abstract
Traumatic injuries of the extrahepatic biliary tract are rare. Associated injuries are usually responsible for immediate indication for surgical treatment, the time when an injury to the extrahepatic biliary ducts may be diagnosed. However, missed injuries are often common. The primary aim of this paper is to describe the clinical features, diagnosis, treatment, and outcome of two patients with left hepatic duct injury after blunt abdominal trauma. As a secondary objective, a literature review is presented. The two cases presented in this study are as follows: (1) A young male, involved in a motor vehicle crash, was admitted with blunt hepatic trauma in a general hospital. Endoscopic retrograde cholangiography was conducted 3 weeks later and revealed a large leakage at the left hepatic duct. Exploratory laparotomy was performed 26 days after the initial traumatic event and identified a complete section of the left hepatic duct, treated with anastomosis. (2) A male fell from a height. On exploratory laparotomy, a 30 % partial injury of the left hepatic duct was found in addition to hemoperitoneum, liver injury, gallbladder detachment together with cystic duct rupture, retroperitoneal hematoma to the right, and cecum hematoma. A high level of suspicion is necessary to identify injuries to the hepatic ducts. Early diagnosis that occurs during laparotomy due to associated injuries is important to reduce complications.
Similar content being viewed by others
References
Brenneman FD, Rizoli SB, Boulanger BR, Hanna SS (1994) Blunt left hepatic duct injury. Injury 25(7):465–7
Ivatury RR, Rohman M, Nallathambi M, Rao PM, Gunduz Y, Stahl WM (1985) The morbidity of injuries of the extra-hepatic biliary system. J Trauma 25(10):967–73
Melton SM, McGwin G Jr, Cross JM et al (2003) Common bile duct transection in blunt abdominal trauma: case report emphasizing mechanism of injury and therapeutic management. J Trauma 54(4):781–5
Nathan M, Gates J, Ferzoco SJ (2003) Hepatic duct confluence injury in blunt abdominal trauma: case report and synopsis on management. SurgLaparoscEndoscPercutan Tech 13(5):350–2
Ramia JM, Gutiérrez G, Garrote D et al (2005) Isolated extrahepatic bile duct rupture in blunt abdominal trauma. Am J Emerg Med 23(2):231–2
Lopez PP, Habib FA, Layke JC, Gonzalez P, Rodriquez E (2005) Complete transection of the common bile duct after blunt trauma: a case report. J Trauma 59(4):1018–21
Sharpe RP, Nance ML, Stafford PW (2002) Nonoperative management of blunt extrahepatic biliary duct transection in the pediatric patient: case report and review of the literature. J PediatrSurg 37(11):1612–6
Bourque MD, Spigland N, Bensoussan AL, Garel L, Blanchard H (1989) Isolated complete transection of the common bile duct due to blunt trauma in a child, and review of the literature. J Ped Surg 24:1068–70
Balzarotti R, Cimbanassi S, Chiara O, Zabbialini G, Smadja C (2012) Isolated extrahepatic bile duct rupture: a rare consequence of blunt abdominal trauma. case report and review of the literature. World J Emerg Surg 7(1):16
Busuttil RW, Kitahama A, Cerise E et al (1980) Management of blunt and penetrating injuries to the porta hepatis. Ann Surg 191(5):641–8
Dawson DL, Jurkovich GJ (1991) Hepatic duct disruption from blunt abdominal trauma: case report and literature review. J Trauma 31(12):1698–702
Posner MC, Moore EE (1985) Extrahepatic biliary tract injury: operative management plan. J Trauma 25(9):833–7
Feliciano DV, Bitondo CG, Burch JM et al (1985) Management of traumatic injuries to the extrahepatic biliary ducts. Am J Surg 150(6):705–9
Jones KB, Thomas E (1985) Traumatic rupture of the hepatic duct demonstrated by endoscopic retrograde cholangiography. J Trauma 25(5):448–9
Muin A, Leong YP, Tay SK (1992) Laceration of the common hepatic duct bifurcation by blunt abdominal trauma. Injury 23(6):422–3
Sheldon GF, Lim RC, Yee ES, Petersen SR (1985) Management of injuries to the porta hepatis. Ann Surg 202(5):539–45
Bade PG, Thomson SR, Hirshberg A, Robbs JV (1989) Surgical options in traumatic injury to the extrahepatic biliary tract. Br J Surg 76(3):256–8
Gerndt SJ, Seidel SP, Taheri PA, Rodriguez JL (1995) Biliary tract injury following blunt abdominal trauma: case reports. J Trauma 39(3):612–5
Michelassi F, Ranson JH (1985) Bile duct disruption by blunt trauma. J Trauma 25(5):454–7
Shuman WP (1997) CT of blunt abdominal trauma in adults. Radiology 205(2):297–306
Sharma BC, Mishra SR, Kumar R, Sarin SK (2009) Endoscopic management of bile leaks after blunt abdominal trauma. JGastroenterolHepatol 24(5):757–61
Eid A, Almogy G, Pikarsky AJ et al (1996) Conservative treatment of a traumatic tear of the left hepatic duct: case report. J Trauma 41(5):912–3
Leppäniemi AK, Jokelainen OS, Haapianinen RK (1993) Accidental injuries of the hepatoduodenal ligament. Eur J Surg 159:351–3
Acknowledgments
The authors acknowledge the funding from the Fundação de Amparo à Pesquisa do Estado de São Paulo with grant number 12698/2010.
Conflict of Interest
None
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Zago, T.M., Pereira, B.M.T., Calderan, T.R.A. et al. Extrahepatic Duct Injury in Blunt Trauma: Two Case Reports and a Literature Review. Indian J Surg 76, 303–307 (2014). https://doi.org/10.1007/s12262-013-0885-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12262-013-0885-5