Abstract
Background: Diagnosis and management of extrahepatic duct injuries in blunt abdominal trauma is very difficult and challenging. First because these injuries are very rare. Also, in the management of abdominal blunt trauma, many patients are currently managed with non-surgical and conservative methods. Case presentation: A 23-year-old man who referred to General Hospital in down town of Tehran due to severe trauma in rollover motorcycle accident. There was no evidence of hemodynamic instability in emergency department. There was a drop in hemoglobin in the first week of hospitalization, which could be due by hepatic artery injury. We decided to manage hepatic artery pseudo aneurysm with interventional radiology approach. On angiography, a picture of a thrombotic pseudoaneurysm was seen, which was embolized by passing a catheter and endovascular coiling. Four days later, he presented with severe abdominal distension. In the study, the abdomen was full of fluid, which was emptied, and about 5 liters of bile were expelled. Twenty-four days after the accident, the patient underwent ERCP and a clear leak of proximal part CBD was evident. CBD stent was inserted under the guide of fluoroscopy. The patient underwent complete intravenous nutrition and the volume of discharge did not decrease during treatment. One week after starting intravenous feeding, the patient developed fever, tachycardia, and abdominal tenderness, so he underwent surgery. Severe adhesions and multiple collections were evident in the abdomen. Abdominal lavage was performed and two right and left sub-diaphragmatic drains were inserted and the abdomen was closed. Enteral feeding began 5 days after the surgery and the patient was discharged in good general condition. Conclusions: This is a rare case of simultaneous hepatic artery and common bile duct injury at the same time which manage with interventional embolization for hepatic artery pseudoaneurysm and ERCP and stenting also total parenteral nutrition for common bile duct injury at first step. At last surgery was done due to control the sepsis and abdominal collections drainage.
Challenges in management of an isolated intrapancreatic Common Bile Duct injury in an abdominal trauma