J Korean Soc Traumatol.  2016 Sep;29(3):93-97. 10.20408/jti.2016.29.3.93.

Successful Endoscopic Treatment of Hepatic Duct Confluence Injury after Blunt Abdominal Trauma: Case Report

• Park CI
• Park SJ
• Lee SB
• Yeo KH
• Choi SU
• Kim SH
• Kim JH
• Baek DH

• KMID: 2359009
• DOI: http://doi.org/10.20408/jti.2016.29.3.93

Abstract

Hepatic duct confluence injury, which is developed by blunt abdominal trauma, is rare. Conventionally, bile duct injury was treated by surgical intervention. In recent decades, however, there had been an increase in radiologic or endoscopic intervention to treat bile duct injury. In a hemodynamically stable patient, endoscopic intervention is considered as the first-line treatment for bile duct injury. A 40 year-old man was transferred to the emergency department of OO trauma center after multiple blunt injuries. Contrast-enhanced abdominal computed tomography performed in another hospital showed a liver laceration with active arterial bleeding, fracture of the sacrum and left inferior pubic ramus, and intraperitoneal bladder rupture. The patient presented with hemorrhagic shock because of intra-peritoneal hemorrhage. After resuscitation, angiographic intervention was performed. After angiographic embolization of the liver laceration, emergency laparotomy was performed to repair the bladder injury. However, there was no evidence of bile duct injury on initial laparotomy. On post-trauma day (PTD) 4, the color of intra-abdominal drainage of the patient changed to a greenish hue; bile leakage was revealed on magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP). Bile leakage was detected near the hepatic duct confluence; therefore, a biliary stent was placed into the left hepatic duct. On PTD 37, contrast leakage was still detected but both hepatic ducts were delineated on the second ERCP. Stents were placed into the right and left hepatic ducts. On PTD 71, a third ERCP revealed no contrast leakage; therefore, all stents were removed after 2 weeks (PTD 85). ERCP and biliary stenting could be effective treatment options for hemodynamically stable patients after blunt trauma.

Keyword

Trauma; Biliary tract; Non-penetrating; Cholangiopancreatography; Endoscopic retrograde

MeSH Terms

Bile
Bile Ducts
Biliary Tract
Cholangiopancreatography, Endoscopic Retrograde
Cholangiopancreatography, Magnetic Resonance
Drainage
Emergencies
Emergency Service, Hospital
Hemorrhage
Hepatic Duct, Common*
Humans
Lacerations
Laparotomy
Liver
Resuscitation
Rupture
Sacrum
Shock, Hemorrhagic
Stents
Trauma Centers
Urinary Bladder
Wounds, Nonpenetrating