Pereira et al reported clinical findings associated with extrahepatic bile duct injury following blunt trauma. The authors are from the Princess Alexandra Hospital and University of Sydney in Australia.
Patient selection: blunt trauma to the torso
Blunt trauma can rarely result in laceration or complete transection of an extrahepatic bile duct. In the series of Pereira et al, over half involved complete transection of the common bile duct (29% suprapancreatic; 23% intrapancreatic).
If the patient had an abdominal laparotomy, then the following findings may be seen after bile duct injury included:
(1) bile-stained porta hepatis
(2) hematoma of the porta hepatis
(3) bile ascites
(4) liver laceration
If the patient did not have a laparotomy, then reasons to investigate included:
(1) delayed hemodynamic instability
(2) development of acute abdomen
(3) bile ascites
(4) jaundice
Causes of delayed diagnosis:
(1) limited initial surgical exploration (if laparotomy performed)
(2) initial nonoperative management
(3) failure to perform an intraoperative cholangiogram
(4) delayed investigation of a persistent, postoperative bile leak
Preoperative diagnosis can be made by ERCP, MRCP, or percutaneous intrahepatic cholangiogram.
