PIPIDA scan diagnosis of traumatic rupture of the gallbladder

Non-surgical trauma to the extrahepatic biliary tract

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.

Surgical options in traumatic injury to the extrahepatic biliary tract

A series of 53 patients who sustained extrahepatic biliary tract trauma were analysed to define the role of the various surgical options. Of the 45 patients with gallbladder injuries, 39 were due to stab wounds. Nine of the 45 injuries were repaired by primary suture without complication. Five patients underwent cholecystostomy and all developed biliary fistulae, which resulted in prolonged hospitalization. Cholecystectomy was performed in 31 patients; in retrospect many of these gallbladders could have been preserved because on only eight occasions was the gallbladder extensively damaged. Of eight extrahepatic bile duct injuries, the three partial transections managed by primary repair had a successful outcome, while the five complete transections were managed by a variety of techniques. Delayed diagnosis, failure of operative recognition of the injury and improper management were factors that led to mortality in two patients and prolonged morbidity in another. We conclude that suture repair is the operation of choice for gallbladder stab wounds without extensive injury. Ductal injury must be recognized. Partial transections are best managed by primary repair. Complete transections should be managed by primary duct jejunal anastomosis if the expertise is available.