Extrahepatic Bile Duct Injury Caused by Blunt Abdomen Trauma: A Case Report

Ghosh, Shaurav; Kazi, Farah Naaz; Sharma, Jatin

doi:10.7759/cureus.25662

Cited by 1 publication

(1 citation statement)

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“…Ghosh et al [ 10 ] recently reported a case of extrahepatic duct injury after blunt trauma that failed to respond to NOM after 2 days in the ICU due to peritonitis. The patient underwent laparotomy and the injury to the main bile duct was not identified during the procedure.…”

Section: Discussionmentioning

confidence: 99%

A 21-Year-Old Man with Previous History of Gastrectomy, Cholecystectomy, and Biliary Stenting with Failed Non-Operative Management of Blunt Trauma to the Liver Due to Traumatic Stent Perforation

Ribeiro Junior,

Almehrzi,

Jaszczak

et al. 2023

Am J Case Rep

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Patient: Male, 21-year-old Final Diagnosis: Perfuration of bile duct due to retained stent after trauma Symptoms: Abdominal pain • blunt abdominal pain Clinical Procedure: Removal of stent graft and stents • surgical intervention Specialty: Surgery Objective: Unusual clinical course Background: Conservative management of blunt trauma to the liver is commonly used when there are no immediate signs of rupture or hemorrhage, but requires patient monitoring. The rate of failure for non-operative management ranges is 3–15%. This report is of a 21-year-old man with a previous history of gastrectomy, cholecystectomy, and biliary stenting with failed non-operative management of blunt trauma to the liver following a motor vehicle crash, due to traumatic stent perforation. Case Report: The patient reported abdominal pain and had positive FAST for fluid in the hepatorenal space. CT abdomen showed grade 3 hepatic injury and a common bile duct stent. He was resuscitated and admitted to the ICU. He developed escalating abdominal pain and tachycardia without hypotension. Repeat CT demonstrated a paraduodenal gas bubble. He underwent exploratory laparotomy, during which the following were found: hemoperitoneum, no active bleeding, a 3-cm blue stent exiting the left hepatic duct surrounded by a fibrous tract, and bile spilling from around the stent. The protruding portion of the stent was resected, the was tract oversewn, and the abdomen was closed. Once stabilized, the patient underwent ERCP with removal of the remaining stent segment. The postoperative course was complicated by surgical wound infection and fascial dehiscence managed operatively and with local wound care, and deep-space infections managed by interventional radiology drainage. Conclusions: Blunt trauma injury of the liver can be successfully managed conservatively. However, this case highlights the importance of knowledge of the patient’s medical history and the presence of biliary stents, which can result in traumatic biliary perforation with an intact liver.

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Section: Discussionmentioning

confidence: 99%