A Novel Technique to Temporize a Destructive Common Bile Duct Injury in an Unstable Poly-Trauma Patient

Abstract

We report a case of a 26-year-old patient presenting as a polytrauma with multiple devastating injuries, including a 1 cm destructive injury to the common bile duct (CBD) along with a laceration to the inferior vena cava (IVC). Studies on temporization strategies for common bile duct injuries in the context of damage control surgery are scarce, and guidelines for management of such injuries are limited due to low quality evidence. Surgical treatment for injuries to the extrahepatic bile ducts are individualized based on location, severity, and stability. In stable patients with less than 50% circumference injuries and healthy common bile duct margins, definitive repair can be attempted primarily. Destructive injuries that encompass greater than 50% circumference in stable patients are more challenging and there is controversy surrounding early versus delayed biliary reconstruction. In this case, an adequately sized T-tube was not available, and closed suction drainage was dismissed due to potential complications with early reconstruction. Due to the patient's critical condition and extraordinary circumstances, a LeMaitre carotid shunt was used to temporize the common bile duct injury for 6 days, a technique not previously described. The patient was then reconstructed with a hepaticojejunostomy in Roux-en-y fashion with a favorable outcome. We believe that this method of temporization may be an especially useful tool in the armamentarium of the surgeon practicing in an austere environment.