Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 16, 2021; 9(20): 5661-5667
Published online Jul 16, 2021. doi: 10.12998/wjcc.v9.i20.5661
Rare isolated extra-hepatic bile duct injury: A case report
Jian Zhao, Yan-Li Dang, Jia-Ming Lin, Chun-Hai Hu, Zhi-Yong Yu
Jian Zhao, Jia-Ming Lin, Chun-Hai Hu, Zhi-Yong Yu, Department of Hepatobiliary Surgery, The Affiliated Hospital of Yunnan University (The Second People's Hospital of Yunnan Province), Kunming 650000, Yunnan Province, China
Yan-Li Dang, Department of Obstetrics, The First People's Hospital of Yunnan Province, Kunming 650000, Yunnan Province, China
Author contributions: Zhao J and Dang YL designed this report; Lin JM and Hu CH followed the patient and recorded his medical information; Zhao J wrote the paper.
Supported by Academician (Expert) Workstation Construction Project of Yunnan Province, No. 2018IC107.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhi-Yong Yu, MD, PhD, Chief Doctor, Department of Hepatobiliary Surgery, The Affiliated Hospital of Yunnan University (The Second People's Hospital of Yunnan Province), No. 176 Qingnian Road, Wuhua District, Kunming 650000, Yunnan Province, China. xsrsyby@sohu.com
Received: March 1, 2021
Peer-review started: March 1, 2021
First decision: April 18, 2021
Revised: April 21, 2021
Accepted: April 28, 2021
Article in press: April 28, 2021
Published online: July 16, 2021
Processing time: 128 Days and 7.1 Hours
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.

CASE SUMMARY

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.

CONCLUSION

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.

Keywords: Bile duct; Injury; Blunt; Abdominal trauma; Diagnosis; Case report

Core Tip: We report the diagnosis and treatment of a rare case of isolated extra-hepatic bile duct injury (EHBDI). This was a case of unexplained peritoneal bile leakage following abdominal trauma in a patient without severe peritoneal irritation, which led to diagnostic difficulties. In particular, no obvious lesion was found after exploratory examination, so only a T-shaped tube was indwelling in the common bile duct. Isolated EHBDI was confirmed by postoperative T-tube angiography and magnetic resonance cholangiopancreatography, and mild common bile duct stenosis was found at follow-up. We believe this is a rare case that deserves to be summarized. Combined with a literature review, we summarize the injury mechanism, clinical manifestations and treatment strategies of solitary EHBDIs.