Blunt trauma to the extrahepatic biliary tract A multicenter study
Emmanouil Pikoulis 1, Panayiotis Daskalakis 1, Efthimios D Avgerinos 1, Evangelia Gougoudi 1, Ioannis Karavokyros 1, Ari Leppäniemi 2, Emmanouil Pavlakis 1, Dimitrios K. Filippou 1, Nikolaos Psalidas 1, Nicolas Condilis 1, Panayiotis Tsatsoulis 1
Affiliations
Article Info
1 First Department of Surgery, Medical School, University of Athens, Athens, Greece, Second Department of Surgery, General Hospital “ASCLEPEION” Voulas, Athens, Greece
2 Department of Surgery, Meilahti Hospital, University of Helsinki, Finland, Second Department of Surgery, General Hospital “ASCLEPEION” Voulas, Athens, Greece
Abstract
BACKGROUND/AIMS: Blunt trauma to the extrahepatic biliary tract is a rare and challenging injury. The purpose of this paper is to review our experience of these injuries, with special reference to their clinical presentation. PATIENTS AND METHODS: In a retrospective multicenter study of the records of a trauma-admitting in three hospitals, seven patients with blunt extrahepatic biliary tract trauma were identified, one with combined gallbladder and common bile duct injuries and six with a ruptured gallbladder. RESULTS: Except for the patient with the common bile duct injury developing peritoneal signs during observation and being operated 24 hours post-admission, all other patients underwent early laparotomy for shock, peritonitis or positive diagnostic peritoneal lavage (DPL) caused by associated injuries. The common bile duct injury was treated with suture repair over a T tube and the gallbladder injuries with cholecystectomy, except for two cases in which a cholecystostomy was performed. CONCLUSIONS: In patients with blunt trauma, especially to the right upper quadrant, a high index of suspicion and liberal use of diagnostic studies to exclude an isolated extrahepatic biliary tract injury is recommended.
Keywords
- Blunt trauma
- Car accident
- Motor vehicle accidents
- Perforation of biliary tract
