traumatic bile duct injury
Introduction
Introduction to traumatic bile duct injury Biliary injury is a broad term that refers to a variety of causes of extrahepatic bile duct injury, such as war wounds, knife wounds, blast injuries, upper abdominal contusions, traffic accidents, upper abdominal surgery, and new technology applications such as certain Accidental injuries such as interventional therapy, liver transplantation, etc. In order to distinguish its nature, cause and injury, it is helpful to guide clinical diagnosis and treatment. The biliary tract injury can be divided into two categories: traumatic and iatrogenic biliary tract injury. The direct result of various biliary tract injuries often manifests as biliary tract infection and bile duct stricture ( Incomplete obstruction) and/or timid formation and subsequent multiple liver and systemic damage. basic knowledge The proportion of illness: 0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: cholangitis, cholecystitis
Cause
Causes of traumatic bile duct injury
(1) Causes of the disease
The biliary tract injury caused by trauma is rare. The causes of injury are mostly blunt trauma such as crush injury, kick injury, injury, etc., or penetrating injury such as puncture, bullet injury, etc. Other visceral injuries, especially rupture of the liver or other structural damage in the hilar region, may also be associated with damage to the stomach and duodenum, pancreas, right kidney, etc., especially the junction of the bile duct pancreatic duct and duodenum behind the head of the pancreas The complex injury of the site, the injury is extremely concealed, must be carefully explored during surgery, and occasionally, the biliary tract injury is caused by broken ribs, and may not be accompanied by other visceral injuries.
(two) pathogenesis
In the traumatic bile duct injury, the gallbladder is more susceptible than the bile duct, and most of the injuries are sharp penetrating injuries. The blunt injury is rare. The extrahepatic bile duct injury is generally divided into gallbladder injury and bile duct injury.
Gallbladder injury
(1) gallbladder rupture: This is the most common injury, often caused by direct trauma, such as gunshot wounds, knife stab wounds, traffic accidents or direct blows, manifested as perforation and laceration of the gallbladder wall, gall bladder filled with bile is easier rupture.
(2) gallbladder tear: rapid deceleration can produce strong shear force, so that the gallbladder filled with bile is removed from the gallbladder bed. If completely avulsed, the gallbladder will be suspended from the gallbladder tube and gallbladder artery on the gallbladder bed.
(3) gallbladder contusion: direct blunt crush injury can cause gallbladder wall contusion, manifested as ecchymosis, or the blood produced fills the entire cyst, slight contusion can be self-healing, but severe gallbladder wall traumatic hematoma can affect Local blood supply, resulting in delayed gallbladder rupture.
(4) Cholecystitis: Hemorrhage in the gallbladder accumulates in the gallbladder, blocking the cystic duct, causing acute cholecystitis.
2. Bile duct injury data indicate that the incidence of extrahepatic bile duct injury is the common bile duct, the right hepatic duct, and the left hepatic duct. Because the common bile duct of the hepatic hilum is curved and elastic, once the deceleration injury or the right upper quadrant compression injury occurs, The liver suddenly moves in the abdomen, creating a shear force above the relatively fixed position of the pancreas, so the rupture of the pancreaticoduodenal junction is most common in blunt trauma.
According to the degree of injury, the following types are classified:
(1) Bile duct contusion: non-full layer injury, no bile leakage.
(2) Simple bile duct injury: a tangential injury in which the length of the wound is less than 50% of the circumference of the tube wall.
(3) Complex bile duct injury: including tangential wound with a wound length greater than 50% of the circumference of the wall, a segmental defect of the bile duct wall, and a complete penetrating injury of the bile duct.
Prevention
Traumatic bile duct injury prevention
Protect your body, it is best not to get hurt, not to get infected.
Complication
Complications of traumatic bile duct injury Complications cholangitis cholecystitis
Biliary injury combined with other organ damage.
Symptom
Traumatic bile duct injury symptoms common symptoms peritonitis jaundice hemorrhage shock bile duct fracture
The main manifestation of biliary rupture is bile spillage. Early wounds from bile or biliary peritonitis are signs of biliary tract injury, but trauma is often a compound injury, especially closed abdominal contusion. The performance of biliary tract injury is often shocked. , intra-abdominal hemorrhage, peritonitis or fractures are concealed by significant symptoms, sometimes biliary pancreatic segmental injury, bile overflow into the peritoneum, no free bile in the abdominal cavity, more likely to be missed during exploration surgery, David reported in cases of closed extrahepatic bile duct injury, More than 50% of the patients have missed the diagnosis during the surgical exploration, and even caused many operations. Therefore, in the exploration of abdominal trauma, the injury to the liver and the external biliary tract, or even the small extrahepatic bile duct or the duodenum. Wall cracks, etc., although in the complex circumstances of multiple combined injuries, as long as the condition allows, should be carefully checked.
The late symptoms of biliary tract injury vary according to the location of the bile duct injury, the degree and the combined injury, but the overall manifestations are biliary tract infection, obstructive jaundice or biliary fistula of the bile duct stenosis. After other injuries are treated, the symptoms of biliary trauma are relatively obvious. And prominent, the diagnosis is also easier to be clear.
Examine
Examination of traumatic bile duct injury
There may be elevated serum bilirubin, hypoproteinemia and increased white blood cell count.
Closed abdominal injury timely abdominal puncture, found in the peritoneal fluid mixed with bile, it has diagnostic significance, related imaging examination before laparotomy, especially B-ultrasound and CT scan, hepatobiliary system loses normal, cholelithiasis around the gallbladder Selective angiography and 99mTc IDA radionuclide scanning are of great value in diagnosing liver damage and bile leakage.
Diagnosis
Diagnosis and diagnosis of traumatic bile duct injury
Because biliary tract injuries often involve other internal organs and simultaneous injury, most patients have corresponding symptoms and need to perform emergency laparotomy because of rupture of other parenchymal organs or perforated peritonitis of the hollow organs. The correct diagnosis is often The diagnosis of biliary tract injury can be established during surgery. It is rare to diagnose the biliary tract injury before surgery. In fact, it is extremely difficult to diagnose biliary tract injury in closed abdominal trauma. Generally speaking, Abdominal severe injury and internal hemorrhage or peritonitis should be performed immediately after exploratory laparotomy, so the exact diagnosis before surgery does not have much practical significance in clinical, but if the injury is open and there is bile overflow, diagnosis Affirmation, surgery should be performed immediately, and comprehensive and careful exploration should be carried out during the operation to determine the type of injury and comorbidities to guide the correct choice of surgery.
Biliary injury combined with other organ damage included.
