Treatment of late biliary stricture after blunt abdominal trauma

Extrahepatic bile duct injury from blunt abdominal trauma is severe and very rare. However, no definitive treatment has been proposed for biliary strictures caused by blunt abdominal trauma.

Four cases of late biliary stricture following the initial repair of the liver rupture because of the blunt abdominal trauma are described. The diagnosis, treatment, and outcome of the complications are discussed.

One patient received bile drainage because of biliary peritonitis on admission. He underwent a right hepatectomy and a Roux-en-Y anastomosis on the left bile duct because of right lobar atrophy 3 months later. Cholangiojejunostomy was performed in the other three patients using the Hepp-Couinaud technique. The patients were followed for 5-37 months, yielding no recurrence of the biliary stricture or cholangitis.

Surgical intervention should be used after the failure of repeating endoscopic stenting or percutaneous drainage. The Hepp-Couinaud technique could provide a wide and accurate leakproof mucosa-to-mucosa anastomosis that is responsible for excellent results.