Management of Common Bile Duct Injuries

A rare case of hepatic duct injury from blunt abdominal trauma

Background:

A 25 year-old male was brought to the emergency room following an apparent suicide attempt by jumping from the fourth floor.

Case Report:

Patient had a large abdominal laceration in the right upper quadrant (RUQ). CT scan showed a sub-scapular hematoma of the liver. Due to the repeated episodes of hypotension, a laporotomy was performed and the left hepatic artery was ligated while the ductal injury was managed with a Roux-en-Y left hepatic jejunostomy and stent. Bile leakage was resolved post-operatively by day 5 and the patient was discharged home on day 13 after clearance from psychiatry.

Conclusions:

While non-iatrogenic extrahepatic biliary trauma is rare, a high degree of suspicion is essential, especially in cases like the one discussed in this report. Diagnosis can be difficult in patients undergoing observation.

Endoscopic approach to the patient with bile duct injury

Laparoscopic cholecystectomy (LC) is complicated by bile duct injury in 0.3% to 0.6% of cases. These injuries range from simple leaks from the cystic duct stump that can almost always be managed by endoscopic stenting to complex strictures, transections, and even resections of the bile duct, often with concomitant vascular damage leading to ischemia. The management of LC-related biliary injuries requires a multidisciplinary approach involving an endoscopist experienced in the use of ERCP, a skilled interventional radiologist, and a surgeon with specific training in the management of hepatobiliary injuries.