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Extrahepatic bile duct injury in blunt trauma

A systematic review

Pereira, Ryan, MBBS; Vo, Tovi, MBBS; Slater, Kellee, MBBS

Journal of Trauma and Acute Care Surgery: May 2019 - Volume 86 - Issue 5 - p 896–901
doi: 10.1097/TA.0000000000002186
SYSTEMATIC REVIEWS
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BACKGROUND Extrahepatic bile duct injuries (EHBDIs) are a rare consequence of blunt abdominal trauma. The purpose of this study was to establish mechanisms of injury, clinical indicators of EHBDI following blunt trauma (both with investigative modalities and intraoperatively), method and timing of injury detection, and definitive treatment options.

METHODS A systematic review was performed to gather data on patients with an EHBDI secondary to blunt trauma. Three databases (MEDLINE, PubMed, and EMBASE) were searched to July 19, 2018.

RESULTS Our systematic review included 51 studies, compromising a study population of 66 patients with EHBDIs sustained from blunt trauma. The three most common injuries included complete transection of the suprapancreatic common bile duct (29%, n = 19), complete transection of the intrapancreatic common bile duct (23%, n = 15) and partial laceration of the left hepatic duct (20%, n = 13). Of the hemodynamically stable group managed nonoperatively (n = 23), mean timing postinjury to diagnosis of EHBDI was 11 days. An EHBDI was recognized at initial laparotomy in 87% (n = 13) of hemodynamically stable patients. An EHBDI was recognized at initial laparotomy in 57% (n = 8) of hemodynamically unstable patients.

CONCLUSION The EHBDIs are a rare yet serious consequence of blunt trauma. To establish a timely diagnosis and limit complications of missed injuries, a heightened awareness is required by the attending surgeon with particular attention to subtle yet important clinical indicators. These vary depending on the hemodynamic stability of the patient and decision to manage injuries conservatively or surgically on presentation.

LEVEL OF EVIDENCE Systematic review, level III.

From the Hepatobiliary and Pancreatic Surgery Unit (R.P., T.V., K.S.), The Princess Alexandra Hospital, Woolloongabba, QLD; and The Whiteley-Martin Research Unit, Discipline of Surgery (R.P.), University of Sydney, Sydney, Australia.

Submitted: October 24, 2018, Revised: December 26, 2018, Accepted: December 29, 2018, Published online: January 8, 2019.

Address for reprints: Ryan Pereira, MBBS, Hepatobiliary and Pancreatic Surgery Unit, Level 4, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, QLD, 4102, Australia; email: ryan.pereira@my.jcu.edu.au.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.jtrauma.com).

© 2019 Lippincott Williams & Wilkins, Inc.