title: Impaction of a shrapnel splinter in the common bile duct after migrating from the right thoracic cavity: report of a case.
abstract: Biliary obstruction is rarely caused by a foreign body. This report describes the case of a 60-year-old Japanese man with jaundice caused by an impacted shrapnel splinter in the common bile duct (CBD) that had migrated from the right thoracic cavity 36 years after initial injury. Biochemical data showed a total bilirubin level of 4.2 mg/dl with a direct bilirubin level of 3.1mg/dl, an alanine aminotransferase level of 24IU/l, and an alkaline phosphatase level of 18.5KA units. It was serially documented that the shrapnel had migrated toward the diaphragm, then burrowed into the liver, settling in the CBD, and causing obstructive jaundice. Choledochotomy and T-tube drainage was performed and the postoperative course was uneventful. To our knowledge, this is the first case report of this type of occurrence in the Japanese literature. Although there are few reports of combat injury in Japan, this diagnosis should be considered in the evaluation of any patient with jaundice who has suffered a previous chest wound involving a foreign body.
authors.affiliation: Department of Surgery, Nagasaki Prefectural Shimabara Onsen Hospital, Nagasaki, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Eguchi
authors.forename: Shigetoshi
authors.initials: S
authors.lastname: Matsuo
authors.forename: Masaaki
authors.initials: M
authors.lastname: Hidaka
authors.forename: Takashi
authors.initials: T
authors.lastname: Azuma
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamaguchi
authors.forename: Takashi
authors.initials: T
authors.lastname: Kanematsu
mesh_terms: D001651:Cholestasis, Extrahepatic / Q000209:etiology*; D003137:Common Bile Duct Diseases / Q000209:etiology*; D005548:Foreign-Body Migration / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D035423:Thoracic Cavity; D013898:Thoracic Injuries / Q000209:etiology; D014857:Warfare