Post-traumatic ischemic necrosis of the common bile duct

A case of blunt injury to the extrahepatic bile ducts is reported. The injury was more likely caused by ischemia than by forces acting directly on the ducts. When disruption occurs at the time of injury, its recognition may be delayed considerably, because the leaked bile is encapsulated or remains sterile and is therefore well tolerated. When there is ischemia without disruption, as in the case presented, perforation due to necrosis may also take some time (days to weeks) to occur. In the interval, loss of appetite, nausea, vomiting, abdominal distension and jaundice may develop. Bile-stained ascitic fluid is present.