Complete avulsion of the papilla of Vater and gastroduodenal artery due to blunt abdominal trauma: report of a case

Rupture of the common bile duct due to blunt trauma, presenting difficulty in diagnosis

Rupture of the common bile duct because of blunt trauma is extremely rare. Preoperative diagnosis is very difficult because bile causes little peritoneal irritation. We present a case of a 19-year-old young woman with rupture of the common bile duct due to blunt trauma. She arrived at our hospital 1 hour after a car accident. She was diagnosed as pancreatic head injury, and conservative therapy was administered. It was effective, but after starting oral intake 6 days after the injury, she presented with abdominal fullness because of increased ascites. The ascites contained large amounts of bile. Rupture of the common bile duct became apparent, thus, she underwent emergency surgery 13 days after the injury. The common bile duct was ruptured completely at the lower bile duct. We repaired it by choledochojejunostomy. Her postoperative course was uneventful, and she discharged on the 12 days after the surgery. Preoperative drip-infusion-cholangiography-CT was useful for its diagnosis.

Traumatic duodenal necrosis with peri-ampullary duodenal detachment

Isolated duodenal injury in blunt abdominal trauma is unusual. Diagnosis requires a complete exploration of the abdominal cavity. The authors present a rare case of disruption and necrosis of the second duodenum with periampullary duodenal detachment.