Extrahepatic bile duct injury caused by a horse kicking injury. Issue 6 (21st June 2019)

• Record Type: Journal Article
• Authors: Pereira, Ryan; Slater, Kellee
• Is Part Of: BMJ case reports. Volume 12:Issue 6(2019)
• Publication Date: 2019-06-21
• Subjects: general surgery -- biliary intervention; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2018-228176
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : A 35-year-old man presented to a regional hospital after being kicked by a horse in the right upper quadrant. He was transferred to our hepatobiliary unit with bile peritonitis 8 days post trauma. Laparoscopic cholecystectomy and intraoperative cholangiography were performed, demonstrating distal common bile duct (CBD) obstruction with contrast extravasation from the distal duct. The CBD was drained with a T-tube via laparotomy. On postoperative day 14, T-tube cholangiography demonstrated no extravasation of contrast from the distal CBD and minor stricturing with eventual duodenal drainage. The T-tube was clamped and 5 weeks later, the patient represented with peri-T-tube bile leakage and right upper quadrant pain. A T-tube cholangiogram confirmed a complex distal CBD stricture. Two attempts at ERCP with intent of stenting the stricture were unsuccessful. The patient underwent an end to side Roux-en-Y choledochojejunostomy and was discharged home 4 days postoperatively on simple analgesia.