Traumatic hepatic duct injury: new approach to surgical management

Blunt traumatic injury to the biliary tract is rare, and its management is one of the most difficult and challenging problems confronting surgeons. If disruption occurs in the hepatic ducts, occult ductal injury may even go unnoticed. A high index of suspicion is the single most important factor leading to the identification and successful management of these injuries. A patient with massive upper abdominal injuries secondary to blunt trauma is reported on. Intraoperative cholangiography demonstrated bilateral hepatic duct transection. The injury was successfully managed by Roux-en-Y hepatoportal enterostomy, an approach that has not been previously reported. Primary repair or hepatic cholangiojejunostomy is the treatment of choice for hepatic duct injuries. Hepatoportal enterostomy, however, offers a satisfactory alternative in treatment when the patient is unstable or when primary repair is not possible. The literature is reviewed and the pathogenesis, diagnosis and treatment of nonpenetrating injuries to the biliary tract are discussed.