Common Bile Duct Stricture Secondary to Repetitive Abdominal Trauma

Abstract

Trauma induced biliary strictures are rare entities. Typically these types of strictures are associated with a major traumatic event, most commonly a MVA. Here we introduce a case of a 19-year-old man who developed a symptomatic benign CBD stricture resulting from repetitive abdominal trauma. Case Presentation: A 19-year-old AA male presented with abdominal pain and pruritis. The initial work up revealed mild elevation in the liver panel studies. An U/S of the abdomen showed no cholelithiasis, choledocholithiasis, or other abnormalities. The patients abdominal pain persisted and he developed jaundice. A further rise in alkaline phosphatase and bilirubin was seen on follow up laboratory studies, consistent with an obstructive process in the biliary tree. This prompted a repeat U/S, which displayed both common bile duct and common hepatic duct dilation. A subsequent CT of the abdomen showed no additional abnormalities. The patient had a MRCP revealing tapering of the distal common bile duct. Consequently the patient underwent an ERCP showing a 3–3.5 cm segment of narrowing in the distal CBD, which was subsequently balloon dilated. Cytology brushings were negative for malignant cells. A stent was placed across the area of stricture, after which the patients liver studies normalized. A liver biopsy was performed, to exclude other conditions such as primary sclerosing cholangitis. This revealed centrolobular cholestasis consistent with large bile duct obstruction. At follow up ERCP the stent was removed with no further evidence of stricture. A social history revealed that the patient was involved in martial arts and his training involved repetitive abdominal blows to strengthen the abdominal wall. This repetitive trauma was the only identifiable cause for the CBD stricture. Discussion: Reports of isolated common bile duct strictures secondary to trauma are few in number. An extensive search of the literature revealed only a few cases showing a biliary stricture as a delayed complication of blunt abdominal trauma, occurring secondary to motor vehicle accidents. To our knowledge an isolated common bile duct stricture secondary to martial arts or sports related abdominal trauma, has not been reported. We propose this as a new etiology for isolated common bile duct strictures. In young patients with an isolated biliary stricture, clinicians should obtain a detailed social history looking for any martial arts training.