Surgical approach for patients with high biliary stricture caused by blunt liver trauma

Abstract

Objective To investigate the treatment for patients with high biliary stricture caused by blunt liver trauma. Methods Clinical data of 3 patients with high biliary stricture caused by blunt liver trauma in the First Affiliated Hospital, School of Medicine, Xi′an Jiaotong University from January 2007 to December 2011 were analyzed retrospectively. There were 2 males and 1 female with the age of 42, 29 and 34 years old respectively according to the sequence of hospitalization. The informed consents of all patients were obtained and the ethical committee approval was received. All the patients were hospitalized due to gradually aggravated jaundice, accompanied by abodominal pain, fever and elevated alkaline phosphatase after operations of blunt liver trauma. Three patients received computed tomography (CT), magnetic resonance cholangiopancreatography(MRCP), endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC), and were diagnosed as biliary stricture of Ⅳ type of Bismuth. Three patients received repeated endoscopic nasobiliary drainage or ERCP stent placement, and the curative effect was poor. The Hepp-Couinaud cholangiojejunostomy was performed to reconstruct the bile duct in 3 patients on 65th, 73rd and 94th d respectively after the operation of blunt liver trauma. Results All the operations were successful. One patient suffered mild bile leakage 4 d after operation and was cured by enhanced drainage. The other 2 cases recovered well and were discharged without complications. The patients were followed up for 3, 14, 37 months and no recurrence of biliary stricture or cholangitis were observed. Conclusions For the high biliary stricture patients caused by blunt liver trauma, Hepp-Couinaud cholangiojejunostomy should be performed to reconstruct the bile duct after repeated failure of interventional treatments. The best operation time may be 2-3 months after the repair operation for blunt liver trauma. Key words: Blunt liver trauma; Abdominal injuries; High bile duct stricture; Portoenterostomy, hepatic