Extrahepatic biliary duct trauma--a spectrum of injuries

Blunt traumatic injury of the extrahepatic bile ducts (EBD) is uncommon. Familiarity with the wide spectrum of possible EBD injuries is essential, however, because of the increasing number of nonpenetrating abdominal injuries seen in modern society. These injuries include contusion with edema, hematoma and varying degrees of laceration. Edema and hematoma can result in transient bile duct obstruction that clears spontaneously or cicatrizing inflammatory reaction resulting in stricture and obstruction. Common bile duct stricture following blunt trauma is extremely rare, but is an unfortunate late complication requiring biliary decompression to relieve progressive jaundice. Laceration (partial or complete) can occur at any location in the EBD and can be life-threatening if the diagnosis is overlooked. Hemobilia is an unusual complication of laceration of the EBD. Failure to recognize the clinical manifestations of these uncommon injuries results in delayed and often incorrect diagnoses. Percutaneous transhepatic cholangiography is a safe and accurate procedure that is an important step in the workup of jaundice following blunt trauma.