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

Abstract

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.

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

“…An ERCP would ascertain the extent of any injuries and enable inserting stents (with sphincterotomy) around strictures or small biliary leaks, enabling these injuries to heal [ 1 , 4 , 5 ]. The upper edge of the pancreas, the hepatic duct bifurcation, and the origin of the left hepatic duct are the common areas of injury to the extrahepatic bile ducts after blunt abdominal trauma [ 4 ].…”

“…Disruption of extrahepatic bile ducts from blunt trauma has been rarely reported [ 1 , 2 ]. Small tears may present as subsequent leaks leading to fistula or stricture [ 3 ].…”

“…An intraoperative cholangiogram is useful in detection and localization of these injuries [ 3 ]. A high level of suspicion is essential if the diagnosis is to be made on initial exploration [ 1 , 3 ]. Jaundice, nausea, vomiting, abdominal distension and pain are common symptoms of a delayed diagnosis [ 1 , 3 ].…”

“…A high level of suspicion is essential if the diagnosis is to be made on initial exploration [ 1 , 3 ]. Jaundice, nausea, vomiting, abdominal distension and pain are common symptoms of a delayed diagnosis [ 1 , 3 ]. A stricture or bile leak from a direct injury or an ischemic insult from injury leading to devascularization of the extrahepatic biliary tree generates these symptoms [ 3 ].…”

Rare isolated extra-hepatic bile duct injury: A case report

“…Extra-hepatic bile duct injury (EHBDI) is rare among all blunt abdominal injuries. Fizeau[ 1 ] first reported the case of common bile duct rupture in 1806. According to current literature statistics, it only accounts for 3%-5% of abdominal injuries[ 2 , 3 ], of which most are combined injuries and 85% are gallbladder injuries.…”