A rare case of hepatic duct injury from blunt abdominal trauma
Nahidh W Hasaniya1, Shyamal Premaratne, Ishani D Premaratne
1Department of Surgery, School of Medicine, Loma Linda University, Loma Linda, CA, U.S.A. ; Department of Surgery, John A. Burns School of Medicine, University of Hawaii and Research Laboratory at the Queen's Medical Center, Honolulu, HI, U.S.A.
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.
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