Abstract: Objective:To investigate the management of traumatic bile duct injury.
Methods:The clinical data of 26 patients with traumatic bile duct injury were retrospectively analyzed. All the patients were admitted to the Tongji Hospital of the Huazhong University of Science and Technology from July 2009 to May 2014. All the 26 patients had the history of trauma. The trauma of the patients were typed according to the Mattox injury typing system. Besides anti shock treatment, cholecystectomy, bile duct repair, end to end anastomosis of bile duct, choledochojejunostomy and quadrate lobectomy+hilar bile duct reshaping+hepaticojejunostomy were selected according to the site and degree of the injury. Symptomatic treatment was applied to patients who were combined with other organs injury. Patients were followed up via out patient examination and telephone interview till October 2014.
Results:Twenty six patients received exploratory laparotomy, and gallbladder injury was detected in 15 patients, common bile duct injury in 5 patients, common hepatic duct injury in 3 patients, left hepatic duct injury in 2 patients, right hepatic duct in 1 patient. Eleven patients were combined with hepatic rupture, 1 with splenic rupture, 5 with renal rupture, 4 with small intestinal rupture. Eleven patients were with type Ⅰ bile duct injury, 4 with type Ⅱ bile duct injury, 8 with type Ⅳ bile duct injury and 3 with type Ⅴ bile duct injury. Of the 15 patients with gallbladder injury, 5 patients with slight bruise of the gallbladder did not receive cholecystectomy. Six patients and 4 patients with type Ⅰ and Ⅱ bruise of the gallbladder received cholecystectomy. Of the 11 patients with hepatic and bile duct injury, 5 patients with type Ⅳ received bile duct repair+T tube drainage, 1 patient with type Ⅳ received end to end bile duct anastomosis+T tube drainage, 1 patient with type Ⅳ received biliojejunostomy and 1 patient with type Ⅳ received quadrate lobectomy+hilar bile duct reshaping+hepatojejunostomy; 3 patients with type Ⅴ received biliojejunostomy. Eleven patients additionally received repair of the liver or hepatectomy, 1 received splenectomy, 5 received nephrectomy, 4 received partial small bowel resection+end to end anastomosis. One patient died of hemorrhagic shock perioperatively; 3 patients were complicated with bile leakage, 1 with incisional infection, and they were cured by symptomatic treatment. Twenty five patients were followed up at postoperative month 1, 3, 6, 12, and no patient was complicated with delayed bile leakage and biliary stricture recurrence.
Conclusion:Traumatic bile duct injury is often diagnosed during the operation. Patients with traumatic bile duct are often combined with shock and other organs injury. As for the treatment, laparotomy should be applied as soon as possible on the base of anti shock treatment, and the appropriate method for biliary reconstruction should be selected according to the site and degree of injury.