PDF(Pubmed)
Abstract：
BACKGROUND: Extra-hepatic bile duct injury (EHBDI) is very rare among all blunt abdominal injuries. According to literature statistics, it only accounts for 3%-5% of abdominal injuries, most of which are combined injuries. Isolated EHBDI is more rare, with a special injury mechanism, clinical presentation and treatment strategy, so missed diagnosis easily occurs.
METHODS: We report a case of unexplained abdominal effusion and jaundice following blunt abdominal trauma in our department. Of which, surgical exploration of the case was performed and a large amount of bile leakage in the abdominal cavity was found. No obvious abdominal organ damage or bile duct rupture was found. Surgery was terminated after the common bile duct indwelled with a T tube. After 2 wk, a T-tube angiography revealed the lesion in the common bile duct pancreatic segment, confirming isolated EHBDI. And 2 mo later, the T tube was pulled out with re-examined magnetic resonance cholangiopancreatography, indicating narrowing of the common bile duct injury, with no special treatment due to no clinical symptoms and no abnormality in the current follow-up.
CONCLUSIONS: This case was featured by intraoperative bile leakage and no EHBDI. This type of rare isolated EHBDI is prone to missed and delayed diagnosis due to its atypical clinical manifestations and imaging features. Surgery is still the main treatment, and the indications and principles of bile duct injury repair must be followed.
METHODS: We report a case of unexplained abdominal effusion and jaundice following blunt abdominal trauma in our department. Of which, surgical exploration of the case was performed and a large amount of bile leakage in the abdominal cavity was found. No obvious abdominal organ damage or bile duct rupture was found. Surgery was terminated after the common bile duct indwelled with a T tube. After 2 wk, a T-tube angiography revealed the lesion in the common bile duct pancreatic segment, confirming isolated EHBDI. And 2 mo later, the T tube was pulled out with re-examined magnetic resonance cholangiopancreatography, indicating narrowing of the common bile duct injury, with no special treatment due to no clinical symptoms and no abnormality in the current follow-up.
CONCLUSIONS: This case was featured by intraoperative bile leakage and no EHBDI. This type of rare isolated EHBDI is prone to missed and delayed diagnosis due to its atypical clinical manifestations and imaging features. Surgery is still the main treatment, and the indications and principles of bile duct injury repair must be followed.
摘要：
背景：肝外胆管损伤（EHBDI）在所有钝性腹部损伤中非常罕见。根据文献统计,它只占腹部损伤的3%-5%，其中大部分是合并伤。孤立的EHBDI更罕见，具有特殊的损伤机制，临床表现和治疗策略，所以很容易发生漏诊。
方法：我们报告了1例不明原因的腹部闭合性外伤后腹腔积液和黄疸。其中，对该病例进行了手术探查，发现腹腔有大量胆漏。未发现明显的腹部器官损伤或胆管破裂。胆总管留置T管后终止手术。2周后，T管血管造影显示胆总管胰腺段病变，确认分离的EHBDI。2个月后，用磁共振胰胆管造影检查拔出T管,提示胆总管损伤狭窄,目前随访无异常，无临床症状，无特殊治疗。
结论：该病例以术中胆漏为特征，无EHBDI。这种罕见的孤立性EHBDI由于其不典型的临床表现和影像学特征，容易漏诊和延迟诊断。手术仍然是主要的治疗方法，必须遵循胆管损伤修复的适应证和原则。
方法：我们报告了1例不明原因的腹部闭合性外伤后腹腔积液和黄疸。其中，对该病例进行了手术探查，发现腹腔有大量胆漏。未发现明显的腹部器官损伤或胆管破裂。胆总管留置T管后终止手术。2周后，T管血管造影显示胆总管胰腺段病变，确认分离的EHBDI。2个月后，用磁共振胰胆管造影检查拔出T管,提示胆总管损伤狭窄,目前随访无异常，无临床症状，无特殊治疗。
结论：该病例以术中胆漏为特征，无EHBDI。这种罕见的孤立性EHBDI由于其不典型的临床表现和影像学特征，容易漏诊和延迟诊断。手术仍然是主要的治疗方法，必须遵循胆管损伤修复的适应证和原则。
