Bile duct disruption by blunt trauma

The rarity of bile duct injury secondary to blunt abdominal trauma leads to frequent delays in diagnosis and inappropriate management. An illustrative case is therefore described and 94 reported cases are reviewed. In 53% of patients, operation was delayed more than 24 hours. Early clinical findings of hypovolemia and acute abdomen are related to associated injuries. Late findings are abdominal distention and jaundice due to the biliary injury. Early diagnosis is facilitated by diagnostic paracentesis. Patients operated on during the first 24 hours after the injury had a statistically higher incidence of bile duct injury distal to the cystic duct (p less than 0.05) and of complete ductal severance (p less than 0.05). The association of location distal to the cystic duct and complete severance was highly significant (p less than 0.001). Management should include biliary exploration. Cholangiography using concentrated water-soluble contrast agents may help to find the anatomy of obscure injuries. The choice of surgical repair must be individualized according to the location and the magnitude of the injury.