Abstract
Extrahepatic hepatic ductal injuries (EHDIs) due to blunt abdominal trauma are rare. Given the rarity of these injuries and the insidious onset of symptoms, EHDI are commonly missed during the initial trauma evaluation, making their diagnosis difficult and frequently delayed. Diagnostic modalities useful in the setting of EHDI include computed tomography (CT), abdominal ultrasonography (AUS), nuclear imaging (HIDA scan), and cholangiography. Traditional options in management of EHDI include primary ductal repair with or without a T-tube, biliary-enteric anastomosis, ductal ligation, stenting, and drainage. Simple drainage and biliary decompression is often the most appropriate treatment in unstable patients. More recently, endoscopic retrograde cholangiopancreatography (ERCP) allowed for diagnosis and potential treatment of these injuries via stenting and/or papillotomy. Our review of 53 cases of EHDI reported in the English-language literature has focused on the evolving role of ERCP in diagnosis and treatment of these injuries. Diagnostic and treatment algorithms incorporating ERCP have been designed to help systematize and simplify the management of EHDI. An illustrative case is reported of blunt traumatic injury involving both the extrahepatic portion of the left hepatic duct and its confluence with the right hepatic duct. This injury was successfully diagnosed and treated using ERCP.
Highlights
Injuries to the extrahepatic biliary system in blunt abdominal trauma are uncommon [1,2,3,4,5,6,7]
Extrahepatic hepatic ductal injuries (EHDIs) occur even less frequently [1,2,3,4,5,6,7,8]. Because of their rarity and the frequently insidious onset of symptoms, EHDIs are commonly missed during the initial trauma evaluation, and debate continues regarding the best way to diagnose and treat them [2, 9]
Extrahepatic hepatic ductal injuries (EHDIs) occur predominantly in men, and the male-to-female ratio increases with patient age [2, 12, 15]
Summary
Injuries to the extrahepatic biliary system in blunt abdominal trauma are uncommon [1,2,3,4,5,6,7]. Extrahepatic hepatic ductal injuries (EHDIs) occur even less frequently [1,2,3,4,5,6,7,8] Because of their rarity and the frequently insidious onset of symptoms, EHDIs are commonly missed during the initial trauma evaluation, and debate continues regarding the best way to diagnose and treat them [2, 9]. Traditional management options in EHDI include primary repair with or without a T-tube, biliary-enteric anastomosis, ductal ligation, stenting, and drainage.
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